目的 观察利多卡因气雾剂对减轻超声实时引导初期自体动静脉内瘘(arteriovenous fistula，AVF)穿刺疼痛的临床效果。 方法 选取北京市海淀医院(北京大学第三医院海淀院区)肾脏内科血液净化中心60例初期AVF穿刺的维持性血液透析患者，利用随机数字分组法将患者分为常规组和利多卡因气雾剂组。常规组按照超声实时引导穿刺的方法进行内瘘穿刺；利多卡因气雾剂组在内瘘穿刺前喷拭利多卡因气雾剂15 min后再进行超声实时引导穿刺。2组患者均在穿刺后进行视觉模拟评分法(visual analogue scale，VAS)评分疼痛，观察2组患者在内瘘穿刺过程中的疼痛程度。 结果 利多卡因气雾剂组与常规组总体穿刺疼痛评分分布比较：利多卡因气雾剂组低于常规组，差异有统计学意义(Z=6.783,P＜0.001)；利多卡因气雾剂组与常规组穿刺疼痛程度构成比比较，无痛与轻度穿刺疼痛的患者比例均高于常规组，差异有统计学意义(χ2=60.000，P＜0.001)。 结论 采用利多卡因气雾剂可减轻超声实时引导初期AVF穿刺给患者带来的疼痛，给患者带来良好穿刺体验，值得临床推广应用。
Objective To observe the clinical effect of lidocaine aerosol on reducing the pain during real-time ultrasound guided puncture in hemodialysis patients with new autogenous arteriovenous fistula (AVF). Methods A total of 60 maintenance hemodialysis patients undergoing new autogenous AVF puncture in our blood purification center were selected as the research subjects. They were divided by using the random number grouping method into a standard group and a lidocaine aerosol group. The standard group underwent routine real-time ultrasound guided puncture, and the lidocaine aerosol group used lidocaine aerosol locally applied on puncture site 15 minutes before the real-time ultrasound guided puncture. Visual analogue scale (VAS) pain scoring was used to assess the pain level during puncture of the new autogenous AVF in the two groups. Results Comparison of the pain score distribution between the two groups found that the pain score was lower in the lidocaine aerosol group than in the standard group (Z=6.783, P＜0.001), and the ratios of no pain and slight pain during the puncture were higher in the lidocaine aerosol group than in the standard group (χ2=60.000, P＜0.001). Conclusion Local use of lidocaine aerosol can significantly reduce the pain during real-time ultrasound guided puncture of new autogenous AVF, bringing a better experience of AVF puncture to the maintenance hemodialysis patients. This method can be widely used in clinical practice.
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