摘要
目的探讨双静脉穿刺作为永久性血管通路在维持性血液透析患者中应用的可行性。方法在上臂中下1／3处扎上止血带，用16号或17号内瘘针直接穿刺肘正中静脉，穿刺成功后将上臂止血带换成弹力绷带，模仿献血员献血时手部握皮球或橡皮圈，不断做握球运动，作动脉端引血，静脉端选择另一侧肘正中静脉或下肢大隐静脉穿刺。双静脉穿刺的透析方法、透析时间、透析频率、使用的透析器及抗凝方法均与同期其他维持性血液透析患者相同。结果长期采用双静脉穿刺作为血管通路的维持性血液透析患者18例，占本透析中心同期维持性血液透析患者的4．84％（18／372）。使用时间6～85个透析月，透析前血清肌酐、尿素氮、白蛋白、铁蛋白及钙、磷、血红蛋白等指标以及在线KT／V值与同期其他维持性血液透析患者比较，差异无统计学意义（P〉0．05）。结论双静脉穿刺操作简单，无血管通路及心肺再循环，透析效率高，对一些无法建立理想长期血管通路的维持性血液透析患者是1个合适的选择。
Objective To explore the applied feasibility of double venipuncture as permanent vascular access in maintenance hemodialysis （MHD） patients. Methods Puncture method of double venipuncture：Firstly, tied a tourniquet in the lower 1/3 of the upper arm, secondly, punctured the vein in the middle of the elbow with No. 16 or 17 fistula needle, and then changed tourniquet with elastic bandage after the success of the puncture, laterly, imitated the blood donors to grip a ball or rubber band at hand and did the movement as the lead of arterial end, fanally, chose another one elbow vein or lower limb sa- phenous vein to puncture as the venous end. Dialysis method, dialysis time, frequency, dialyser and antico- agulation methods were the same with the other MHD patients in the corresponding period. Results Eighteen cases adopted double venipuncture as long-term vascular channel in MHD, accounted for 4.84% of the dialysis center（18/372）. In 6-85 month use time, the index of serum creatinine, urea nitrogen, albu- min, iron protein, calcium, phosphorus, hemoglobin before dialysis, and online KT/V value in MHD pa- tients with this method had no significant differences with those in the other MHD patients, P 〉 0.05. Conclusion The double vein puncture is simple to operate without vascular access and cardiopulmonary recycle, and with this method, the dialysis efficiency is high, so it is a good choice for those MHD patients who can not establish ideal long-term vascular access.
出处
《临床内科杂志》
CAS
2013年第1期40-42,共3页
Journal of Clinical Internal Medicine
