CAJ | 학술논문

目的比较动静脉内瘘普通穿刺、钝针扣眼穿刺和改良型钝针扣眼穿刺对维持性血液透析患者的影响,选择安全、有效的内瘘穿刺方法.方法将90例采用动静脉内瘘作为血管通路的维持性血液透析患者随机分为A(30例,普通穿刺)、B(30例,钝针穿刺)和C(30例,改良型钝针穿刺)3组.6个月后,比较3组患者穿刺相关并发症、生化指标和透析充分性,对影响穿刺并发症的相关因素进行多变量Cox回归模型分析.结果 C组患者穿刺点剧痛、内瘘狭窄的发生率低于A、B组,而内瘘血肿、假性动脉瘤的发生率低于A组(均P ＜0.05).6个月后,C组患者C反应蛋白水平低于A、B组,血红蛋白水平高于A、B组(均P＜ 0.05),组间URR、Kt/V水平差异无统计学意义(均P＞0.05).多变量Cox回归模型分析显示,影响内瘘穿刺并发症的主要因素是透析龄、血红蛋白和C反应蛋白.结论改良型钝针扣眼穿刺法能明显降低透析患者穿刺点血肿、假性动脉瘤、血管狭窄的发生率,减轻透析患者的微炎症状态,且不影响透析充分性.内瘘穿刺的并发症可能与透析龄、血红蛋白、C反应蛋白水平密切相关.
목적 비교동정맥내루보통천자、둔침구안천자화개량형둔침구안천자대유지성혈액투석환자적영향,선택안전、유효적내루천자방법.방법 장90례채용동정맥내루작위혈관통로적유지성혈액투석환자수궤분위A(30례,보통천자)、B(30례,둔침천자)화C(30례,개량형둔침천자)3조.6개월후,비교3조환자천자상관병발증、생화지표화투석충분성,대영향천자병발증적상관인소진행다변량Cox회귀모형분석.결과 C조환자천자점극통、내루협착적발생솔저우A、B조,이내루혈종、가성동맥류적발생솔저우A조(균P ＜0.05).6개월후,C조환자C반응단백수평저우A、B조,혈홍단백수평고우A、B조(균P＜ 0.05),조간URR、Kt/V수평차이무통계학의의(균P＞0.05).다변량Cox회귀모형분석현시,영향내루천자병발증적주요인소시투석령、혈홍단백화C반응단백.결론 개량형둔침구안천자법능명현강저투석환자천자점혈종、가성동맥류、혈관협착적발생솔,감경투석환자적미염증상태,차불영향투석충분성.내루천자적병발증가능여투석령、혈홍단백、C반응단백수평밀절상관.
Objective To learn the impact of blunt needle puncture and improved buttonhole blunt needle puncture on maintenance hemodialysis patients.Methods Ninety hemodialysis patients with arteriovenous fistula as vascular access were randomly assigned to group A (n =30,ordinary puncture),B (n =30,blunt needle puncture) and C (n =30,improved blunt needle puncture).Puncture related complications,biochemical markers and dialysis adequacy of the patients were compared after 6 months.Multivariate Cox regression was used for data analysis.Results The incidence of puncture site pain and fistula stenosis of the group C was lower than that of the group A and B,and the incidence of fistula hematoma and pseudoaneurysm was lower than group A (P ＜0.05).In group C,CRP level of the patients was lower than group A and B,although HGB level was higher than the other two groups after six months (P ＜ 0.05).In Cox multivariate regression,the main factors of fistula puncture complications were dialysis age,HGB and CRP.Conclusions The improved grommets blunt needle puncture method can significantly reduce the incidence of dialysis puncture site hematoma,pseudoanemysm and stenosis,and reduce microinflammation of dialysis patients.Fistula puncture comphcations may be associated with dialysis age,HGB and CRP level.