Abstract: Objective　To compare the effects of trocar and ordinary steel needle (16G) in arteriovenous graft (AVG) puncture for dialysis patients. Methods　From January 2018 to January 2021, 30 patients who received maintenance hemodialysis using AVG as vascular access in Blood Purification Centre, The Fifth Affiliated Hospital of Guangzhou Medical University were selected, including 18 males and 12 females, with an age of (40.2±5.1) years old. Trocar puncture was used in the first 10 times of each patient, and steel needle puncture was used in the last 10 times to establish a self-control. The pain sensation, elbow range of motion, arterial pressure and venous pressure, incidence of subcutaneous hematoma, and hemostasis time by finger pressing in the patients punctured with two kinds of puncture needles were observed. Independent sample t test was used for the measurement data, and Fisher exact probability method was used for the count data. Results　The arterial pressures in the patients punctured with trocar and steel needle (16G) were (-50±18) mmHg (1 mmHg=0.133 kPa) vs. (-70±22) mmHg after the blood flow velocity become steady and (-55±21) mmHg vs. (-76±23) mmHg 3 hours after dialysis, the arterial pressures were (105±15) mmHg vs. (140±22) mmHg and (108±16) mmHg vs. (145±23) mmHg, and the differences were statistically significant (all P<0.05). There were statistically significant differences in the elbow range of motion [(2.33±0.61) vs. (1.25±0.53)] and hemostasis time by finger pressing [(7.08±2.11) min vs. (12.12±3.15) min] between the patients punctured with trocar and steel needle (16G) (both P<0.05); there was no statistically significant difference in the pain perception during puncture (P>0.05). Conclusion　The use of trocar for AVG puncture for hemodialysis treatment can improve the patients' comfort and safety, obtain better blood flow and vascular patency, reduce the incidence of subcutaneous hematoma and long-term complications, thus improve the quality of life.

Key words: Hemodialysis, Arteriovenous graft, Arteriovenous trocar

摘要： 目的　对比观察透析用套管针与普通钢针（16G）在人工血管内瘘（arteriovenous graft，AVG）穿刺使用中的效果。方法　选取2018年1月至2021年1月在广州医科大学附属第五医院血液透析中心使用AVG作为血管通路进行维持性血液透析治疗患者30例，其中男18例、女12例，年龄（40.2±5.1）岁，每例前10次采用套管针穿刺，后10次采用钢针穿刺，采用自身对照。观察患者在2种穿刺针穿刺治疗过程中的疼痛感、肘部活动度、动静脉压力、皮下血肿发生例数、指压止血时间。计量资料采用独立样本t检验，计数资料采用Fisher精确概率法。结果　套管针及16G钢针上机血流速度稳定后动脉压及透析后3 h的动脉压值［（-50±18）mmHg（1 mmHg=0.133 kPa）比（-70±22）mmHg及（-55±21）mmHg比（-76±23）mmHg］、静脉压值［（105±15）mmHg比（140±22）mmHg及（108±16）mmHg比（145±23）mmHg］比较，差异均有统计学意义（均P<0.05）。套管针与16G钢针肘部活动度［（2.33±0.61）分比（1.25±0.53）分］、指压止血时间［（7.08±2.11）min比（12.12±3.15）min］比较，差异均有统计学意义（均P<0.05）；穿刺时疼痛感比较差异无统计学意义（P>0.05）。结论　使用套管针进行AVG穿刺行血液透析治疗，可提高患者的舒适度和安全性，获取更好的血流量及血管通畅性，降低皮下血肿以及远期并发症的发生率，从而达到提高患者生活质量的目的。

关键词: 血液透析, 人工血管内瘘, 动静脉套管针