目的 探讨多扣眼穿刺法对血液透析动静脉内瘘(arteriovenous fistula，AVF)血管内膜增生及穿刺点感染的影响。 方法 选取2023年1月─4月在苏州市第九人民医院血液净化中心行规律血液透析患者60例，依据随机数字法分为单扣眼穿刺组(30例)和多扣眼穿刺组(30例)。分别在扣眼穿刺前及扣眼穿刺3个月、6个月、12个月时的非透析日测量患者AVF穿刺区域的血管内膜增生厚度、血流量、动脉阻力指数，并统计扣眼穿刺点感染情况。 结果 穿刺方法使用3个月、6个月、12个月时，多扣眼穿刺组的AVF血管内膜增生厚度均低于单扣眼穿刺组(t=3.246、5.585、6.055，P=0.002、＜0.001、＜0.001)，AVF血流量均高于单扣眼穿刺组(t=2.697、4.551、7.504，P =0.009、＜0.001、＜0.001)，AVF动脉阻力指数低于单扣眼穿刺组(t=3.254、4.779、5.336，P=0.001、＜0.001、＜0.001)。2组患者的AVF血管内膜增生厚度、动脉阻力指数均随时间变化而增加趋势(F时间=70.030、74.750，均P时间 ＜0.001)，AVF血流量则随时间变化而降低趋势(F时间=42.610，P时间＜0.001)。2组的AVF血管内膜增生厚度、血流量及动脉阻力指数的变化均与穿刺时间存在交互效应(F交互 =16.740、6.640、14.070，均P交互＜0.001)。多扣眼穿刺组的穿刺点感染发生率低于单扣眼穿刺组(χ2=4.812，P =0.028)。 结论 对AVF使用扣眼穿刺技术时，多扣眼穿刺能减轻血管内膜增生、降低穿刺点感染率。
Objective To investigate the effect of multiple buttonhole puncture on intimal hyperplasia in arteriovenous fistula (AVF) and puncture point infection in hemodialysis patients. Methods We select 60 patients undergoing regular hemodialysis at the Blood Purification Center of Suzhou Ninth People's Hospital from January to April 2023 as the research subjects. According to the random number method, they were divided into single buttonhole puncture group (30 cases) and multiple buttonhole puncture group (30 cases). The intimal thickness, blood flow and arterial resistance index at AVF puncture area were measured before buttonhole puncture and on non-dialysis day at 3, 6 and 12 months after buttonhole puncture. Infection at the buttonhole puncture site was also observed. Results In the multi buttonhole puncture group after using this puncture method for 3, 6 and 12 months, the intimal thickness in AVF was lower (t=3.246, 5.585 and 6.055 respectively; P=0.002,＜0.001 and ＜0.001 respectively), natural blood flow in AVF was higher (t=2.697, 4.551 and 7.504 respectively; P=0.009,＜0.001 and ＜0.001 respectively), and arterial resistance index of AVF was lower (t=3.254, 4.779 and 5.336 respectively; P=0.001,＜0.001 and ＜0.001 respectively), as compared with those in the single buttonhole puncture group. Intimal thickness in AVF and arterial resistance index increased over time (Ftime=70.030 and 74.750, Ptime ＜0.001), while natural blood flow in AVF decreased over time (Ftime=42.610, Ptime＜0.001) in both groups. The changes of intimal thickness in AVF, natural blood flow, and arterial resistance index had an interaction effect with puncture time in both groups (Finteraction=16.740, 6.640 and 14.070 respectively; Pinteraction＜0.001). The overall incidence of infection at the puncture site was lower in the multi buttonhole puncture group than in the single buttonhole puncture group (χ2=4.812, P=0.028). Conclusion When using the buttonhole puncture technique for blood access from AVF, multiple buttonhole puncture can reduce intimal hyperplasia in AVF and lower the infection rate at the puncture site.
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