维持性血液透析患者疑难内瘘穿刺研究进展

张启丽 彭春香 甘措

【摘要】  自体动静脉内瘘是血液透析患者最常用的血管通路，在临床上证明是最佳的长期血管通路，但临床穿刺过程中发现，对疑难内瘘血管的穿刺成功率偏低，给患者带来极大的痛苦，加重患者的心理负担，内瘘的使用寿命也一般比较短，严重影响血液透析的质量，并提高了住院率和死亡率。文章主要从疑难内瘘的特点、穿刺方式的选择、护士穿刺观念与管理以及穿刺要点等方面进行综述，希望进一步提高内瘘穿刺成功率，提升护理质量，降低自体动静脉内瘘并发症的发生，延长内瘘血管使用寿命，改善患者结局，推动相关技术的不断完善与探索在疑难内瘘穿刺过程中发挥更重要的作用。

【关键词】  血液透析；疑难动静脉内瘘；穿刺方法；穿刺技巧；护士管理

中图分类号  R692.5   文献标识码  A    文章编号  1671-0223（2024）13--04

Research progress of difficult arteriovenous fistula puncture in hemodialysis patients  Zhang Qili， Peng Chunxiang， Gan Cuo. Chengdu Jinniu People's Hospital， Chengdu 610036， China

【Abstract】  Autologous arteriovenous fistula is the most commonly used vascular access for hemodialysis patients， which has been clinically puncture， it is found that the puncture success rate of difficult internal fistula vessels is low， which brings great pain and aggravates the psychological burden of patients. The service life of internal fistula is generally short， which seriously affects the quality of hemodialysis. And increased hospitalization and mortality rates. This paper mainly reviewed the characteristics of difficult internal fistula， selection of puncture methods， puncture concepts and management of nurses， and puncture points， hoping to further improve the successful puncture rate of internal fistula， reduce the occurrence of complications of autologous arterio-venous fistula， and extend the service life of internal fistula vessels. The specific content is introduced in this paper.

【Key words】 Hemodialysis; Difficult arteriovenous fistula; Puncture method; Puncture techniques; Nurse management

血液透析（HD）可有效延长终末期肾脏病（ESRD）患者的生命周期，而稳定、畅通的血管通路则是确保HD治疗顺利进行的保障[1]。血管通路是HD患者的生命线[2]，更是确保充分透析的前提条件。自体动静脉内瘘（AVF）具有血流量丰富、不易感染、使用方便、创伤小、安全可靠、并发症少的优点，大量文献说明AVF是HD首选的血管通路[3-5]，随着HD技术的日趋发展，患者透析质量的提高，生存期的延长，患者年龄的增长，合并糖尿病、高血压病、内瘘成熟不良等原因及新透析中心骤增，护士培训及穿刺水平不完善等原因，透析通路问题日渐突出，穿刺困难的疑难血管比例逐渐增多[6]，穿刺成功与否直接影响内瘘使用寿命及透析充分性[7]。……