Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan.
Dialysis Center, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan.
Semin Dial. 2023 Nov-Dec;36(6):454-461. doi: 10.1111/sdi.13142. Epub 2023 Feb 1.
Arteriovenous fistula or arteriovenous graft is essential to long-term survival and quality of life in patients receiving hemodialysis. To date, no research has examined the clinical impacts of different puncture methods. This study compared the rope ladder and area puncture techniques in terms of vascular patency, pain, and quality of life among patients receiving hemodialysis.
A prospective longitudinal study was performed with 6-month follow-up. A total of 98 participants recruited from a hemodialysis center in Taiwan were randomly assigned to receive the rope ladder technique (experimental group) or the area puncture technique (control group). Vascular patency was assessed by examining access flow and percutaneous transluminal angioplasty rate. Pain and quality of life were measured using the Numerical Pain Rating Scale (NPRS) and Kidney Disease Quality of Life Instrument (KDQOL-36™), respectively. All outcome variables were measured repeatedly and analyzed using a generalized estimating equation.
Overall, quality of life was significantly better for the experimental group than for the control group (β = 47.23, p < 0.001). The percutaneous transluminal angioplasty rate was lower for the experimental group than for the control group (12.0% vs. 18.8%). However, no significant differences were found in access flow and pain level between the two groups over time.
Hemodialysis patients who received the rope ladder puncture technique had a lower percutaneous angioplasty rate and better quality of life than patients who received the area puncture technique, suggesting that the rope ladder technique could be implemented as a routine cannulation method in hemodialysis clinics.
动静脉瘘或动静脉移植物对于接受血液透析的患者的长期生存和生活质量至关重要。迄今为止，尚无研究探讨不同穿刺方法的临床影响。本研究比较了绳梯和区域穿刺技术在接受血液透析的患者中的血管通畅率、疼痛和生活质量方面的差异。
采用前瞻性纵向研究，随访 6 个月。共有 98 名参与者从台湾一家血液透析中心招募，随机分为绳梯组（实验组）或区域穿刺组（对照组）。通过检查通路流量和经皮腔内血管成形术率来评估血管通畅率。使用数字疼痛评分量表（NPRS）和肾脏病生活质量量表（KDQOL-36™）分别测量疼痛和生活质量。所有结局变量均重复测量，并使用广义估计方程进行分析。
总体而言，实验组的生活质量明显优于对照组（β=47.23，p<0.001）。实验组的经皮腔内血管成形术率低于对照组（12.0% vs. 18.8%）。然而，两组在通路流量和疼痛水平方面在不同时间点均无显著差异。
与接受区域穿刺技术的患者相比，接受绳梯穿刺技术的血液透析患者的经皮血管成形术率较低，生活质量更好，提示绳梯技术可作为血液透析诊所的常规置管方法。
