目的 观察基于患者需求视角下护士超声引导动静脉内瘘穿刺培训效果。 方法 采用方便抽样方法抽取东南大学附属中大医院血液净化中心34名护士作为研究对象，随机分为试验组和对照组，每组各17名，试验组采用基于患者需求视角下超声引导动静脉内瘘穿刺培训，对照组采用常规培训方法，观察2组护士穿刺例数，首次穿刺成功率，穿刺相关并发症，总体穿刺成功率，护士超声引导穿刺掌握率，掌握该项操作所需的穿刺次数。 结果 共32名护士完成了本研究，试验组与对照组各16名。2组护士共计超声引导穿刺了41名患者，其中试验组28名，对照组13名，2组护士首次穿刺成功率无显著差异(78.6%比76.9%,c2=0.000，P=1.000)，试验组护士总体穿刺成功率高于对照组护士(96.1%比89.9%, c2=8.242，P=0.004)，试验组护士超声引导穿刺掌握率高于对照组(81.3%比43.8%,c2=4.800，P=0.028)，试验组护士掌握超声引导穿刺操作所需穿刺次数为13.0(12.0,14.0)，少于对照组16.0(15.0,17.0)(Z=-13.000，P＜0.001)。 结论 基于患者需求视角下超声引导动静脉内瘘穿刺培训能提高透析患者疑难血管通路总体穿刺成功率，提高护士培训效果。
Objective To observe the effect of ultrasound-guided arteriovenous fistula puncture training for nurses based on the perspective of patients’ demands. Methods Thirty-four nurses in the dialysis center were divided into experimental group or control group by convenience sampling method, with 17 in each group. The experimental group used ultrasound-guided arteriovenous fistula puncture training based on patients' demands, while the control group used conventional training methods. Number of patients subjected to the puncture, success rate of first puncture, puncture-related complications, overall success rate of the puncture, master rate of ultrasound-guided puncture training, and number of puncture required by the operation training were observed in the two groups. Results A total of 32 nurses were enrolled and completed the study, and 16 in each group. A total of 41 patients were su bjected to ultrasound-guided puncture, including 28 in the experimental group and 13 in the control group. There was no significant difference in the success rate of first puncture between the two groups (78.6% vs. 76.9%, c2=0.000, P=1.000). The overall puncture success rate of experimental group was significantly higher than that of control group (96.1% vs. 89.9%, c2=8.242, P=0.004). The master rate of ultrasound-guided puncture training for nurses in experimental group was significantly higher than that in control group (81.3% vs. 43.8%, c2=4.800, P=0.028). The median number of puncture times (interquartile distance) required for nurses to master ultrasound-guided puncture in experimental group was 13.0 (12.0, 14.0), significantly less than that in control group of 16.0 (15.0, 17.0) (Z=-13.000, P＜0.001). Conclusions The method of ultrasound-guided arteriovenous fistula puncture training based on patients' needs can significantly improve the overall puncture success rate in hemodialysis patients with difficult vascular access and the training effect of nurses.
[1]Al- Jaishi AA, Oliver MJ, Thomas SM, et al.Patency rates of the arteriovenous fistula for hemodialysis: a systematic review and meta- analysis[J].Am J Kidney Dis, 2014, 63(3):464-478
[2]Cheng Q, Zhao YJ.The reasons for the failure of the primary arteriovenous fistula surgery in patients with end- stage renal disease[J].J Vasc Access, 2015, 16(Suppl 10):S74-S77
[3]Smith GE, Gohil R, Chetter IC.Factors affecting the patency of arteriovenous fistulas for dialysis access[J].J Vasc Surg, 2012, 55(3):849-855
[4]中国医院协会血液净化中心分会血管通路工作组.中国血液透析用血管通路专家共识(第2版)[J].中国血液净化, 2019, 18(6):365-381
[5]肖光辉, 张丽红, 詹申等.掌上超声实时引导自体动静脉内瘘初期穿刺效果的初步观察[J].中国血液净, 2018, 17(9):633-635
[6]Tadashi Kamata, Mayumi Tomita, Noriyuki Iehara.Ultrasound-guided cannulation of hemodialysis access[J].Renal Replacement Therapy, 2016, 2(19):2-7
[7]José Manuel López álvarez, etal.Ultrasound guided pediatric vascular cannulation byinexperienced operators: outcomes in a training model[J].Journal of Ultrasound, 2021, 2(5):45-46
[8]O.Pérez-Quevedo, etal..Designandapplication of model for training ultrasound-guided vascular cannulation in pediatric patients[J].Med Intensiva., 2016, 40(6):364-370
[9]José Manuel López-álvarez, etal.Evaluationof rainingin Pediatric Ultrasound guided Vascular Cannulation Using a Model[J].Journal of Medical Ultrasound, 2020, 6(12):67-68
[10]雷花, 温贤秀, 肖静蓉等.基于病人需求视角下护理人力配置研究[J].护理研究, 2015, 29(9):3091-3092
[11]张秀, 龚平, 王建红, 等.维持性血液透析病人的护理需求调查[J].护理研究, 2006, 20(24):2177-2179
[12]中国医师协会肾脏病医师分会血液透析充分性协作组.中国血液透析充分性临床实践指南[J].中华医学杂志, 2015, 95(34):2748-2753
[13]赵新菊，左力.血液透析充分性临床实践指南更新版-开始血液透析的时机解读[J].中国血液净化, 2016, 15(8):385-387
[14]王玉洁, 徐懋, 李民, 等.住院医师两种股神经阻滞麻醉教学学习曲线的比较[J].中华医学教育杂志, 2019, 39(12):946-949
[15]Alavi A, Amjadi N.A review on considerations needed educating new physicians[J].J Med Life, 2015, 8(Spec Iss 3):1-5
[16]王宁, 李民, 郭向阳, 徐懋, 王军.超声引导桡动脉穿刺置管学习曲线的建立[J].中华医学教育杂志, 2016, 36(02):295-299
[17] [J].A prospective comparison of ultrasound-guided and blindly placed radial arterial catheters[J].Acad Emerg Med, 2006, 13(12):1275-1279
[18]刘振华.加强专科医师培训管理的思考与对策[J].继续教育研究, 2010, 11(1):49-50
[19]邓娅, 邓世雄.新形势下完善住院医师规范化培训制度的研究[J].重庆医学, 2011, 40(13):1337-1339
