维持性血液透析患者血管内瘘功能丧失修复后的护理

Nursing Care of Patients with Maintenance Hemodialysis after Repair of Function Loss of Vascular Fistula

摘要: 目的：探讨维持性血液透析患者血管内瘘功能丧失修复后的护理措施。方法：回顾性分析本院2018年5月~2018年11月收治的30例维持性血液透析治疗中发生血管内瘘功能丧失患者临床资料，对患者血管内瘘功能丧失的原因进行分析，并针对具体原因采取对应的修复护理措施。结果：所有患者修复术后早期内瘘穿刺和透析治疗均顺利完成，修复后首次穿刺时有22例血管选择为内瘘侧肢体动静脉针穿刺透析，另8例为下肢或对侧肢体穿刺静脉回血。有5例出现血肿，发生率为16.67%，包括3例穿刺渗血导致的皮下血肿、2例拔针后压迫不当导致的皮下血肿，经冰袋冷敷、及时压迫止血、24 h后热敷等对症干预后血肿好转，2 d后消失。持续观察1 d，患者均未出现穿刺处感染、血栓、假性动脉瘤等并发症。结论：维持性血液透析过程中低血压、内瘘使用不当、血栓形成是导致患者血管内瘘功能丧失的主要原因，采取对应的穿刺护理、拔针后护理、并发症预防等措施能减少高危因素，降低血管内瘘功能丧失的风险，提高患者生存质量。

Abstract: Objective: To explore the nursing measures for patients with maintenance hemodialysis after re-pair of functional loss of vascular internal fistula. Methods: Clinical data of 30 patients with loss of vascular internal fistula function during maintenance hemodialysis treatment in our hospital from May 2018 to November 2018 were retrospectively analyzed. Causes of loss of vascular internal fistula function in patients were analyzed, and corresponding repair and nursing measures were taken according to specific causes. Results: All patients successfully completed the puncture and dialysis treatment for the early postoperative internal fistula in all patients. When the first punc-ture was performed after repair, 22 cases of blood vessels were selected for the arteriovenous puncture dialysis in the limbs of the fistula side, and the other 8 cases were punctured venous re-turn blood in the lower limbs or the contralateral limbs. There were 5 cases of hematoma with an incidence of 16.67%, including 3 cases of subcutaneous hematoma caused by puncture bleeding and 2 cases of subcutaneous hematoma caused by improper pressure after needle extraction. After symptomatic intervention such as ice bag cold compress, timely pressure to stop bleeding, and hot compress after 24 h, the hematoma improved and disappeared after 2 d. After continuous ob-servation for 1 d, no complications such as puncture infection, thrombosis, or pseudoaneurysm occurred. Conclusion: In the process of maintenance hemodialysis, hypotension, fistula use unde-served, and thrombosis in patients with intravascular fistula are the main reasons for the loss of function. Adopting corresponding targeted nursing, nursing, and complications after pulling needle prevention measures can reduce the risk factor, reduce the risk of loss function of vascular internal fistula, and improve the quality of survival.