Galante Nelson Zocoler, Rabelo Lúcia Lima, Yamamoto Atsuko, Bonato Rozana Aparecida, Azevedo Luiz Sergio
Nephrology and Dialysis Unit, Hospital Cruz Azul, Sâo Paulo CEP: 01538-000, SP, Brazil.
J Ren Care. 2010 Jun;36(2):73-80. doi: 10.1111/j.1755-6686.2010.00152.x.
The buttonhole technique of access of needle insertion into a single selected site in the arteriovenous fistula has proved to be a reliable alternative to older methods due to its overall low complication rates. Although the use of blunt needles improves the technique, the success rate of cannulation with these needles is difficult to predict. We analysed the short-term outcome of 16 patients receiving in-centre haemodialysis and compared clinical relevant parameters between patients with and without buttonhole technique failure. Our dialysis unit treats about 180 patients and is located in a tertiary hospital in Sao Paulo, Brazil. The variables as discussed in the paper were the same for both groups. The incidence of technique failure was 43.7%. Patients enrolled later in the study had a better buttonhole failure-free survival rates than patients enrolled at the beginning (p < 0.05). Patients' clinical characteristics did not predict the success rate of buttonhole tunnel tracks cannulation with blunt needles. This paper also reports on our successes and failures in buttonhole technique and gives some reasons and reflections for both.
事实证明，在动静脉内瘘的单个选定部位采用纽扣式穿刺技术进行穿刺，由于其总体并发症发生率较低，是一种比传统方法更可靠的选择。尽管使用钝针可改进该技术，但使用这些针进行插管的成功率难以预测。我们分析了16例接受中心血液透析患者的短期结果，并比较了纽扣式穿刺技术成功与失败患者之间的临床相关参数。我们的透析单元位于巴西圣保罗的一家三级医院，约有180名患者接受治疗。两组患者的论文中所讨论的变量相同。技术失败的发生率为43.7%。研究后期入组的患者纽扣式穿刺无失败生存率高于研究开始时入组的患者（p<0.05）。患者的临床特征无法预测钝针纽扣式隧道穿刺的成功率。本文还报告了我们在纽扣式穿刺技术方面的成功与失败，并给出了相应的原因和思考。
