Objective:To compare with hemodialysis in blood flow than patient weight 4 times,and not more than 4 times patient weight blood flow,and between improved arterial end tip piercing the centripetal direction and the traditional inverse direction of heart puncture of dialysis fistula blood vessels inside the effect and influence.Method:Uremic patients with maintenance hemodialysis by taken internal fistula vascular puncture from April 2012 to November 2012 in hospital were selected,altogether collected blood samples of 594,and were randomly divided into the observation group and the control group;the observation group was treated with blood flow more than the weight of 4 times,the observation group 1 and group 2 were punctured by the direction of the heart and inverse respectively.In the control group was treated with the blood velocity of not more than 4 times patient weight,the control group 1 and group 2 were punctured by the direction of the heart and inverse direction respectively.The numbers of dialysis were 2-3 times per week. Then Kt/V value,success rate of internal fistula puncture and patient’s pain among four groups were compared.Result:The Kt/V value of observation group patients was better than that of control group,and Kt/V value was basically the same after dialysis between the observation group 1 and group 2.The control group 1 and group 2 Kt/V value was basically the same after dialysis.The improved puncture method had higher success rate of puncturing and less patient pain.Conclusion:According to effect of scavenging the toxin,the method of improved blood flow velocity more than patient weight 4 times is better than using stents weight not more than 4 times the blood flow velocity.Improved arterial end tip piercing the centripetal direction does not affect the dialysis effect,but may protect the internal fistula blood vessels,and reduces patient’s pain.%目的：比较血液透析中血液流速超过病员体重4倍与血液流速不超过病员体重4倍，改进的动脉端针尖向心方向穿刺与传统的逆心方向穿刺对透析效果和内瘘血管的影响。方法：选取2012年4-11月在本院采取内瘘血管穿刺行维持性血液透析的尿毒症病员，共采血样594份，随机分为观察组和对照组。观察组采用血液流速超过病员体重4倍，观察组1与观察组2分别采用向心与逆心方向穿刺；对照组采用血液流速不超过病员体重4倍，对照组1与对照组2分别采用向心与逆心方向穿刺，四组透析次数均为2~3次/周，比较Kt/V值、内瘘穿刺成功率与病员的疼痛感。结果：观察组病员Kt/V值优于对照组，观察组1与观察组2透析后Kt/V值基本相同，对照组1与对照组2透析后Kt/V值基本相同，改进的穿刺方法，穿刺成功率高，病员疼痛感轻。结论：采用改进的血液流速超过病员体重4倍，对毒素的清除效果大于采用血液流速不超过病员体重4倍，改进的动脉端针尖向心方向穿刺不影响透析效果，保护了内瘘血管，减轻了病员的痛苦。
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