动静脉内瘘再循环的影响因素及护理对策-课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Company Logo,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Company Logo,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Company Logo,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Company Logo,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Company Logo,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Company Logo,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Company Logo,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Company Logo,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Company Logo,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Company Logo,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Company Logo,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Company Logo,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Company Logo,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Company Logo,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Company Logo,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Company Logo,*,Click to edit Master title style,动静脉内瘘再循环的影响因素及护理对策,指导老师：王 伟,答辩人：,界首,市人民医院 李娟,2015,年血液净化专科护士综述答辩,引言,动静脉内瘘是维持性血液透析患者赖以生存的“生命线”。随着血液透析患者生存率的大大提高，生活质量成为临床关注的问题。血管通路再循环直接影响着患者的透析充分性，而透析充分性又影响着患者的生活质量和生存期,1,。,1周龙珍，董一民，李杰.在线OCM监测在血透血管通路再循环中的应用J.医学理论与实践，2014,27（19）,：2585-2586,.,再循环的概述,再循环测定的临床意义,影响再循环的因素,护理对策,3,2,4,1,主要内容,5,小结,再循环的概述,血管通路,再循环是指透析时部分已经净化的血液未经全身循环而经动脉端再次进入体外循环,2,。,2 叶朝阳.血液透析血管通路技术与临床应用M.第版.上海:复旦大学出版社,2013,再循环测定的临床意义,1,再循环明显降低透析的效率，对相对分子量较大的毒素物质影响不明显，而对小分子物质如,尿素氮,的清除影响较大。,2,再循环可以正确提示动静脉内瘘的状况。若在临床检查并确认穿刺点的间距正确时出现再循环，则可能是由于血管狭窄或血栓的影响。,动静脉内瘘再循环影响因素,因素,1,动静脉内瘘血 流量,2,血管通路狭窄,3,动静脉压力,4,穿刺针间距,5,穿刺方向,6,穿刺斜面,7,穿刺针内径大小,8,在同一条血管上 穿刺,9,动静脉内瘘针反 接,动静脉内瘘血流量,动静脉内瘘血流量600ml/min时，穿刺间距大于4cm不会引起再循环，动静脉内瘘自然血流量600 ml/min，再循环随间距的缩短而增大，只有间距10cm时无再循环,10,。,当血流量8 cm，再循环仍然存在,12,。,10,苏红，吴灏，黄军月，等.动静脉内瘘穿刺间距选择与再循环发生的护理问题J.中国血液净化，2007,6：,401-403.,12,唐春苑，叶晓青，王饶萍，等.维持性血液透析患者动静脉内瘘的测定J.中华现代护理杂志，2011,17(7):785-787.,血流量充足的前提下，只要保证动静脉两针间距,8 cm，并使用16 G带背孔的穿刺针，,针尖斜面向下,穿刺时没有血液再循环，能够达到充分透析的要求,15,16,。对血管壁损伤小，血管不易扩张，减少内瘘狭窄及闭塞的发生,15,。,1,5,严贺，金凤兰，童辉，等.两种穿刺方法对动静脉内瘘并发症和患者疼痛的影响J.护理学杂志，2014,29(1):24-26.,1,6,王雪梅，贾磊.针尖斜面向下穿刺动静脉内瘘的可行性研究J.齐鲁护理杂志，2010,16（18）:5-6.,穿刺斜面,内瘘血流量不足,穿刺前未仔细评估血管,在同一条血管上穿刺,这种情况应在对侧或者下肢选一静脉作为回路，可减少通路再循环，提高透析效果,1,。,1周龙珍，董一民，李杰.在线OCM监测在血透血管通路再循环中的应用J.医学理论与实践，2014,27（19）：,2585-2586.,护士工作疏忽,动静脉针反接,经过净化的血液回到上游段，并且从血管的下游段被引出，导致再循环。,小结,了解动静脉内瘘再循环的影响因素，有利于指导护士正确使用血管通路，做到以预防为主，早发现，早干预，有效避免血管通路再循环，对提高血液透析患者血管通路的使用寿命，降低并发症，提高患者透析效率有着重要的意义,。,敬请各位老师提出宝贵意见,谢谢！,