目的:探讨由多名穿刺者成功完成纽扣式穿刺皮下隧道形成的可能性.方法:按照由单人或多人完成穿刺,以及是否描记穿刺血管走向,将96名已经存在前臂内瘘的维持性血液透析患者分成4组,每组24人.进行最初的10次穿刺后,观察皮下隧道形成的情况.对4组的穿刺的成功率进行X2检验,按照X2分割法调整α水准后进行组间比较.结果:单人描记血管组和多人不描记血管组组间皮下隧道的形成成功率差别有统计学意义X2=10.084,P＜0.01,其他各组之间皮下隧道的形成成功率无差异.结论:进行内瘘血管走向描记并且单独一人完成穿刺是纽扣式皮下隧道形成的最佳穿刺模式；可以通过描记血管走向的方法弥补多人穿刺带来的缺点,由多人穿刺来完成纽扣式穿刺皮下隧道.%Objective: To explore the possibility of completion the button-type puncture form subcutaneous tunnel successfully by multiple of operators. Method: According to the completion of the puncture by single or multiple, and whether tracing the vascular, 96 hemodialysis patients were randomly divided into four groups, with 24 cases in each group. After the initial 10 puncture , observed the formation of the subcutaneous tunnel. Using Chi square test, the puncture success rate of each group, and conduct interclass comparisons. Result: Among the four groups, there was significant difference in achievement ratio of forming subcutaneous tunnel between the single-tracing vascular group and the multiple operators-no tracing vascular group (X2 = 10.084, P < 0.01), there was no significant difference among other groups. Conclusion: The best pattern of forming the button-type subcutaneous tunnel is tracing the fistula vascular and completed the puncture by single. In addition, the puncture defects which brought by multiple of operators can compensate by tracing the vascular, thus to complete the button-type puncture form subcutaneous tunnel successfully by multiple of operators.
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