目的 构建疑难自体动静脉内瘘扣眼穿刺管理方案，并探讨其在血液透析患者中的应用效果。 方法 基于文献回顾及专家函询法构建疑难自体动静脉内瘘扣眼穿刺管理方案。设计扣眼穿刺信息交接单和扣眼穿刺示意图。选取2020年9月—2022年1月浙江省某三级甲等医院血液净化中心收治的77例伴有疑难自体动静脉内瘘的血液透析患者为研究对象，按随机数字表法将其分入试验组（n=38）、对照组（n=39）。对试验组采取疑难自体动静脉内瘘扣眼穿刺管理方案，对对照组采取常规扣眼穿刺管理方案。比较两组钝针一次进针成功率、动静脉内瘘感染率、扣眼穿刺处血管内膜增生度及扣眼使用寿命≥12个月者占比。 结果 试验组钝针一次进针成功率高于对照组，扣眼穿刺处血管内膜增生度低于对照组，扣眼使用寿命≥12个月者占比高于对照组（P<0.05）；两组动静脉内瘘感染率比较，差异无统计学意义（P>0.999）。结论 疑难自体动静脉内瘘扣眼穿刺管理方案在血液透析患者中的应用可提高钝针一次进针成功率，延缓扣眼穿刺处血管内膜增生，延长动静脉内瘘扣眼使用寿命，值得推广、应用。

Objective To establish a management program for difficult autologous arteriovenous fistula buttonhole puncture and to explore its application effect in hemodialysis patients. Methods Based on literature review and expert consultation，a management program for difficult autologous arteriovenous fistula buttonhole puncture was developed. A buttonhole puncture information handover sheet and a buttonhole puncture diagram were designed. A total of 77 hemodialysis patients with difficult autologous arteriovenous fistula treated in the blood purification center of a tertiary hospital in Zhejiang Province from September 2020 to January 2022 were selected as the study subjects. They were randomly divided into the experimental group（n=38） and the control group（n=39） using a random number table. The experimental group received the management program for difficult autologous arteriovenous fistula buttonhole puncture，while the control group received the conventional buttonhole puncture program. The success rate of one-time blunt needle insertion，arteriovenous fistula infection rate，vascular intimal hyperplasia at the buttonhole puncture site，and buttonhole with a service life of ≥12 months rate were compared between the two groups. Results The success rate of one-time blunt needle insertion in the experimental group was higher than that in the control group，the degree of vascular intimal hyperplasia at the buttonhole puncture site was lower than that in the control group，and the buttonhole with a service life of ≥12 months rate was higher than that in the control group （P<0.05）. There was no significant difference in the arteriovenous fistula infection rate between the two groups（P>0.999）. Conclusion The application of the management program for difficult autologous arteriovenous fistula buttonhole puncture in hemodialysis patients can improve the success rate of one-time blunt needle insertion，delay vascular intimal hyperplasia at the buttonhole puncture site，and prolong the service life of arteriovenous fistula buttonholes，which is worthy of promotion and application.