【摘要】目的探讨动静脉内瘘气囊压迫式止血带的应用效果。方法选取2020 年8 月~2020 年10月在杭州市红十字会医院血液净化中心行维持性血液透析治疗,血管通路为动静脉内瘘的60 例患者为研究对象,随机分为观察组和对照组,每组30 例,观察组使用动静脉内瘘气囊压迫式止血带止血,对照组使用弹性绑带或人工按压止血,观察3 个月,比较2 组止血效果(渗血、肿胀、假性动脉瘤、淤血)。结果2组患者共行2282 次止血,观察组止血效果(渗血、肿胀、假性动脉瘤、淤血)优于对照组,差异有统计学意义(χ2值分别为25.356、18.355、28.762、25.287,P 值分别为0.047、0.033、0.036、0.050)。结论动静脉内瘘气囊压迫式止血带通过压力调节进行止血,效果优于传统方法,方便护士操作,能提高患者舒适度,值得临床推广。
【Abstract】Objective To investigate the effect of a balloon compression tourniquet for arteriovenous fistula. Methods A total of 60 maintenance hemodialysis (MHD) patients using arteriovenous fistula as the blood access route and treated in the Blood Purification Center of Hangzhou Red Cross Hospital from August 2020 to October 2020 were enrolled as the research subjects. They were randomly and equally divided into the observation group, in which the balloon compression tourniquet was used to prevent from bleeding at the puncture site, and the control group, in which elastic bandage or manual pressure was applied to the puncture site. The hemostasis effects including the presence of bleeding at the puncture site, swelling, pseudoaneurysm and hypodermic ecchymosis were compared between the two groups after the intervention for 3 months. Results A total of 2,282 times of pressure hemostasis were performed in the two groups. The hemostatic effects including the absence of bleeding at the puncture site, swelling, pseudoaneurysm and hypodermic hemorrhage were significantly better in the experimental group than in the control group (χ2=25.356, 18.355, 28.762 and 25.287 respectively; P=0.047, 0.033, 0.036 and 0.050 respectively). Conclusion The hemostasis function of the balloon compression tourniquet for the prevention of arteriovenous fistula bleeding after puncture can be regulated by controling pressure level in the tourniquet, with the effect better than the traditional hemostasis methods. This tourniquet is easy to be manipulated, relatively comfortable for the patients, and worthwhile to be widely used clinically.
[1]Arhuidese I J, Orandi B J, Nejim B, et al.Utilization,patency,and complications associated with vascular access for hemodialysis in the United States[J].J Vasc Surg, 2018, 68(4):1166-1174
[2]莫雅文,黄静雅,孙春艳,等.维持性血液透析病人自体动静脉内瘘功能的评价与干预现状[J].护理研究, 2020, 34(01):119-122
[3]Anatole MD,Henry F,Detroit MI,et al. Clinical practice guidelines for vascular access[J].Am J Kidney Dis, 2006, 48(Suppl 1):S248-S273
[4]金其庄,王玉柱,叶朝阳,等.中国血液透析用血管通路专家共识第版[J].中国血液净化, 2019, 18(06):365-381
[5]周宇君,赵颀.种压迫止血方法在血液透析患者内瘘穿刺后的止血效果体会[J].内蒙古医科大学学报, 2018, 40(01):279-281
[6]卢丹,吴亿,王殿珍.种压迫止血方法在血液透析患者内瘘穿刺后的止血效果观察[J].中国血液净化, 2015, 14(09):572-573
[7]袁静,李恒,应金萍,等.例血液透析患者动静脉内瘘血栓形成的原因及护理[J].中华护理杂志, 2020, 55(04):607-610
[8]夏建妹,王黎梅,王荣.外科手术患者手镯保护套的设计与应用[J].护理与康复, 2019, 18(04):94-95