不同穿刺方法对维持性血液透析患者自体动静脉内瘘影响的研究

目的对比3种不同穿刺方法对维持性血液透析患者自体动静脉内瘘的影响。方法接受维持性血液透析的120例终末期肾病患者,根据动静脉内瘘穿刺方向的不同分为向心组、交替组、离心组,每组40例。3组观察时间均为1年,比较3种方法对患者透析效果及内瘘并发症发生率的影响。结果3组动静脉内瘘血流量和透析充分性指标(尿素下降率、尿素清除指数)比较,差异无统计学意义(P>0.05)。向心组发生1(2.50%)例内瘘闭塞、8(20.00%)例内瘘狭窄和1(2.50%)例动脉瘤;交替组发生2(5.00%)例内瘘狭窄和2(5.00%)例动脉瘤;离心组发生6(15.00%)例内瘘闭塞、1(2.50%)例内瘘狭窄和10(25.00%)例动脉瘤。结论向心与离心交替穿刺可以减少维持性血液透析患者动静脉内瘘闭塞、狭窄的发生率,降低血管瘤的形成风险,对提高患者的生活质量具有积极意义。

Comparative study on the effect of three different puncture methods on autologous arteriovenous fistula in maintenance hemodialysis patients

Objective To investigate the effects of three different puncture methods on autologous arteriovenous fistula in maintenance hemodialysis patients.Methods A total of 120 patients with end-stage renal disease were selected.All the patients were treated with maintenance hemodialysis.According to the different puncture directions,patients were divided into three groups(40 cases in each group),centripetal puncture group,alternating puncture group and centrifugal puncture group.The patients in three groups were observed for one year,and the effects of dialysis and incidence of internal fistula complications were compared.Results There were no significant differences in blood flow,urea reduction ratio(URR)and Standard Kt/V(urea)among the three groups(P>0.05).There was 1(2.50%)case of arteriovenous fistula occlusion,8(20.00%)cases of fistula stenosis and 1(2.50%)case of arterial aneurysm in the centripetal puncture group.There were 2(5.00%)cases of fistula stenosis and 2(5.00%)cases of arterial aneurysm in the alternating puncture group.There were 6(15.00%)cases of arteriovenous fistula occlusion,1(2.50%)case of fistula stenosis and10(25.00%)cases of arterial aneurysm in the centrifugal puncture group.Conclusion The alternating method of centripetal puncture and centrifugal puncture can reduce the risk of developing arteriovenous fistula occlusion,fistula stenosis and arterial aneurysm in maintenance hemodialysis patients.