140例维持性血液透析患者退出原因分析

摘要

Objective:To analysis and research the author in blood purification center maintenance hemodialysis patients out of reason and related risk factors affecting the survival rate.Method:Retrospectively analyzed in June 2006-June 2013 in the author’s hospital blood purification center of 328 maintenance hemodialysis patients with clinical data.During a total of 140 patients,according to exit the reason divided into death group,renal transplantation,turn to other hospital group,change of peritoneal dialysis (PD) and for economic reasons and other exit 5 groups;The death group according to the cause of death was divided into:cardiovascular disease,cerebrovascular disease,serious infection,systemic failure and malignant tumor 5 subgroups;Existing 188 MHD patients as control group.Result:Patients with maintenance hemodialysis was more than 3 months of 140 cases of quit,quit rate was 42.68%,exit the main reason for death (67.14%) and transfer (14.29%),the cause of death is mainly for cardiovascular diseases (37.23%),primary disease death group was given priority to with chronic nephritis and diabetic nephropathy. Death was compared between group group of average age is bigger,because of systemic failure and cardiovascular disease deaths more apparent,death group blood albumin levels lower than the control group,the systemic failure,severe infection and malignant tumor group was more obvious. Conclusion:The author in blood purification center maintenance hemodialysis patients withdrew from the main reason for death and courtyard,the leading cause of death for cardiovascular disease,the occurrence of complications associated with primary disease,including diabetes,age and malnutrition is one of the important factors affect survival,elderly patients with high risk for systemic failure and malignant tumor,reasonable dialysis prescription can significantly improve the patients survival rate and quality of life.%　　目的：分析研究笔者所在血液净化中心维持性血液透析患者退出原因及影响生存率的相关危险因素。方法：回顾性分析2006年6月-2013年6月于笔者所在医院血液净化中心进行维持性血液透析的328例患者的临床资料。期间共140例患者退出，按退出原因分为死亡组、肾移植组、转其他医院组、改腹膜透析(PD)组和因经济原因及其他退出5组；其中死亡组按死亡原因分为：心血管病、脑血管病、严重感染、全身衰竭和恶性肿瘤5个亚组；以现存188例MHD患者为对照组。结果：维持性血液透析大于3个月的患者140例退出，退出率42.68%，退出原因主要为死亡(67.14%)和转院(14.29%)，死亡原因主要为心血管疾病(37.23%)，死亡组原发病以慢性肾炎和糖尿病肾病为主。组间比较死亡组平均年龄较大，因全身衰竭和心血管病死亡者更明显，死亡组血白蛋白水平低于对照组，其中全身衰竭、严重感染及恶性肿瘤组更明显。结论：笔者所在血液净化中心维持性血液透析患者退出的主要原因为死亡和转院，死亡的主要原因为心血管疾病，并发症的发生与原发疾病有关，其中糖尿病、高龄和营养不良是影响生存率的重要因素，老年患者发生全身衰竭和恶性肿瘤的风险高，合理的透析处方能显著提高患者生存率和生活质量。