167例维持性血液透析患者死亡的危险因素分析

doi:10.3969/j.issn.1004-583X.2018.08.012

摘要/Abstract

摘要： 目的探讨维持性透析患者死亡原因及相关危险因素，为临床维持性透析患者提供科学的诊疗依据。方法对10年中本中心所有维持性透析患者死亡情况进行调查，并就死亡组和同期维持期透析的存活组进行临床、实验室资料对比分析。结果本中心维持性透析患者总死亡率8.8%（167/1 894）。随着透析龄的延长，死亡比例逐渐增高（r=0.367，P<0.05）。从死亡患者的年龄构成上看，60岁以上者居多，占42.5%（71/167）；从原发疾病死亡构成上看，糖尿病肾病居多，占31.7%(53/167), 原发性肾小球疾病次之，占25.1%(42/167)，再次为高血压肾病，占12.6%(21/167)。死亡原因包括心血管并发症40.7%(68/167），感染36.5%(61/167)和卒中11.9%(20/167)。死亡组血压控制达标率明显低于存活组（P<0.01），透析前平均收缩压和舒张压明显高于存活组（P<0.05），患者血清白蛋白水平、血红蛋白水平明显低于存活组（P<0.05），Kt/V值明显低于存活组（P<0.05），血磷、甲状旁腺素(PTH)水平均明显高于存活组（P<0.05），透析间期体重增长明显高于存活组（P<0.05）；死亡组每周透析不足8小时者比例明显低于存活组(P<0.01）。Logistic回归分析显示，透析前平均高收缩压、舒张压，低血清蛋白水平、低血红蛋白水平， Kt/V水平、每周透析时间不足8小时、高血磷水平、高PTH水平是维持性透析患者死亡的主要危险因素（P<0.05）。结论维持性透析患者死亡的主要原因是心脑血管并发症。高血压、每周透析时间不足8小时、透析充分性低、营养不良、高血磷、高PTH是导致患者死亡的主要危险因素。

关键词: 肾透析, 危险因素, 死亡率

Abstract: Objective To explorethe causes of death and related risk factors in patients with maintenance hemodialysis(MHD), and provide scientific basis for the diagnosis and treatment of of such patients.Methods To investigate the mortality of all maintenance dialysis patients in our center during the past 10 years, and to compare the clinical and laboratory data between the death group and the survival group of maintenance dialysis at the same time.Results The total mortality of maintenance dialysis patients was 8.8% (167/1694). With the prolongation of dialysis age, the proportion of death increased gradually (r=0.367, 0.05). According to the age composition of the dead patients, 42.5% (71/167) were over 60 years old, 31.7% (53/167) were diabetic nephropathy, 25.1% (42/167) were primary glomerular diseases, and 12.6% (21/167) were hypertension nephropathy. The causes of death included cardiovascular complications 40.7% (68/167), infection 36.5% (61/167) and stroke 11.9% (20/167). The comparison of clinical and laboratory data between the death group and the survival group during maintenance hemodialysis showed that the control rate of blood pressure in the death group was significantly lower than that in the survival group (P<0.01), the mean systolic and diastolic blood pressure before hemodialysis was significantly higher than that in the survival group (P<0.05). The Kt/V value was significantly lower than that of the survival group (P<0.05), the levels of serum phosphorus and PTH were significantly higher than those of the survival group (P<0.05), the weight gain during the dialysis interval was significantly higher than that of the survival group (P<0.05), and the proportion of the death group with less than 8 hours of dialysis per week was significantly lower than that of the survival group (P<0.01). Logistic regression analysis showed that high systolic blood pressure, diastolic blood pressure, low serum protein level, low hemoglobin level, Kt/V level, less than 8 hours of dialysis time per week, high serum phosphorus level and high PTH level were the main risk factors of death in maintenance dialysis patients (P<0.05).Conclusion The main causes of death in maintenance hemodialysis patients are cardiovascular diseases. Hypertension, dialysis less than 8 hours weekly, inadequate dialysis, hypophosphatemia，hyperthyroidemia and malnutrition were significant risk factorsfor death in patients with maintenance dialysis.

Key words: renal dialysis, risk factor, mortality

周小春，王晓玲，赵鹏鸣，李静晶，舒红，王俭勤. 167例维持性血液透析患者死亡的危险因素分析[J]. 临床荟萃, doi: 10.3969/j.issn.1004-583X.2018.08.012.

Zhou Xiaochun, Wang Xiaoling, Zhao Pengming, Li Jingjing, Shu Hong, Wang Jianqin. Analysis of the risk factors of death in 167 patients with maintenance hemodialysis[J]. Clinical Focus, doi: 10.3969/j.issn.1004-583X.2018.08.012.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2018.08.012

https://huicui.hebmu.edu.cn/CN/Y2018/V33/I8/695

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167例维持性血液透析患者死亡的危险因素分析

Analysis of the risk factors of death in 167 patients with maintenance hemodialysis

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