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| 个体化血管穿刺图在维持性血液透析患者自体动静脉内瘘管理中的应用效果 |
| Application Effect of Individualized Vascular Puncture Mapping in Autogenous Arteriovenous Fistula Management of Maintenance Hemodialysis Patients |
| 投稿时间：2026-06-10 修订日期：2026-08-10 |
| DOI： |
| 中文关键词: 血液透析 自体动静脉内瘘 血管穿刺图 全流程管理 瘤样扩张 |
| 英文关键词:hemodialysis autogenous arteriovenous fistula vascular puncture mapping full-process management aneurysmal dilation |
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| 中文摘要: |
| 目的 探究超声评估联合个体化血管穿刺图全程干预模式在维持性血液透析（MHD）患者自体动静脉内瘘（AVF）穿刺护理中的应用效果。方法 采用回顾性队列研究方法，选取2022年1月—2023年12月本院血液透析中心124例首次启用AVF的MHD患者为研究对象，依据院内穿刺图技术推广时间自然分组。将2022年1—12月采用传统绳梯式经验穿刺护理的68例患者设为对照组，2023年1—12月开展超声个体化穿刺图护理的56例患者设为观察组，两组均持续随访24个月。对比两组患者穿刺一次性成功率、AVF瘤样扩张及内瘘栓塞发生率。结果 24个月随访显示，观察组累计穿刺17472例次，一次性穿刺成功率98.87%，高于对照组的98.56%（21216例次），差异有统计学意义（χ2=7.12，P<0.01），观察组穿刺失败例次较对照组减少108例。观察组AVF瘤样扩张发生率为0.00%，低于对照组的7.35%，差异有统计学意义（χ2=4.286，P<0.05）。观察组内瘘栓塞发生率1.79%，低于对照组7.35%，两组差异无统计学意义（P=0.208），但观察组存在明显临床获益趋势。结论 超声引导下个体化血管穿刺图全程护理模式，可有效规范MHD患者AVF穿刺操作，提升穿刺同质化水平，减少血管机械性损伤，降低内瘘瘤样扩张发生风险。该干预方式操作简便、无需额外设备，适合基层及各级医院血液净化中心推广，对保护患者血管通路、改善透析预后具有积极作用。 |
| 英文摘要: |
| Objective To explore the application effect of whole-course nursing mode of individualized vascular puncture map guided by ultrasound in autogenous arteriovenous fistula (AVF) puncture for maintenance hemodialysis (MHD) patients. Methods A retrospective cohort study was conducted on 124 MHD patients with newly used AVF in our hemodialysis center from January 2022 to December 2023. Patients were divided into observation group (56 cases, ultrasound-guided individualized puncture map nursing) and control group (68 cases, conventional rope-ladder puncture nursing) according to the promotion time of new technology. Both groups were followed up for 24 months. The one-time puncture success rate and incidence of vascular complications were compared between the two groups. Results The one-time puncture success rate of the observation group was 98.87%, which was higher than 98.56% of the control group (χ2=7.12, P<0.01). The number of puncture failures in the observation group was 108 times less than that in the control group. The incidence of aneurysmal dilation in the observation group was 0.00%, significantly lower than 7.35% in the control group (χ2=4.286, P<0.05). There was no significant difference in the incidence of internal fistula embolism between the two groups (P=0.208), while the observation group showed a favorable clinical trend. Conclusion The whole-course nursing mode of individualized vascular puncture map can standardize AVF puncture operation, improve nursing homogeneity, reduce vascular injury and decrease the risk of aneurysmal dilation. It is convenient and economical, worthy of clinical promotion for protecting vascular access of MHD patients. |
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