终末期肾脏疾病患者透析治疗的相关因素分析

Relevant factor analysis of patients with end-stage renal disease after treatment with dialysis

目的:回顾性分析终末期肾脏疾病透析患者病因、年龄、性别与选择血液透析和全部腹膜透析的关系。方法:收集2003-01/2004-05中南大学湘雅二医院病案统计室、血液净化中心及腹透中心终末期肾脏疾病透析患者资料356例,血液透析患者307例,全部腹膜透析患者49例。血液透析患者采用日本东丽公司,美国百特公司,德国费森-尤斯公司和贝朗公司的血液透析机,采用双醋酸纤维膜、血仿膜和合成膜;空心纤维透析器,透析液为碳酸氢盐透析液,采用肝素(普通肝素或低分子肝素)抗凝,透析时血流量为200～280mL/min,透析液流量为500mL/min,患者透析频率及时间为每周两三次,每次4～4.5h。全部腹膜透析患者采用解剖法置入腹膜透析导管,腹膜透析方法为持续不卧床腹膜透析,腹膜透析外管连接方式为美国百特公司双联系统,腹膜透析液使用含葡萄糖的透析液。分别记录患者姓名、性别、年龄、原发疾病、血尿素氮,肌酐(取患者第一次透析前清晨空腹采血所测数值)、透析的方式等资料,进行统计和分析,分析其病因及其与年龄、性别、透析方式选择的关系。结果:透析患者356例全部进入结果分析。①终末期肾脏疾病透析患者主要病因为慢性肾小球肾炎(52.0%),其次为糖尿病肾病(16.0%),高血压肾病(13.2%),梗阻性肾病(9.0%);男女之比为1.87∶1,平均年龄为(51±16)岁。②腹膜透析患者的平均年龄明显高于血液透析患者[(59±15),(50±16)岁,P<0.05]。86.2%的患者选择血液透析,13.4%选择腹膜透析;糖尿病肾病患者选择腹腹膜透析高于血液透析(P<0.01)。③结缔组织病、慢性肾小球肾炎组患者年龄较小,狼疮平均年龄仅40岁;高血压肾病、糖尿病肾病、梗阻性肾病、痛风、多发性骨髓瘤患者年龄较大,40岁以上患者约95.0%,平均年龄约60岁,与慢性肾炎、狼疮比较,差异有显著性意义(P<0.05)。结论:本组患者以中老年为主,男性多见;终末期肾脏疾病透析患者主要病因为慢性肾小球肾炎,其次为糖尿病肾病;糖尿病肾病首选腹膜透析。

AIM： To retrospectively analyze the relationship of related factors such as etiology, age, sex with hematodialysis and total peritoneal dialysis in patients with end-stage renal disease（ESRD）. METHODS： The data of 356 ESRD patients, 307 hematodialysis patients and 49 total peritoneal dialysis patients, who were from Medical Record Room, Blood Purification Center and Peritoneal Dialysis Center, Second Xiangya Hospital, Central South University from January 2003 to May 2004, were collected. Hematodialysis patients received hemodialysis machine from Japan Dongli Company, America Beite Company, Germany Feisen-Yousi Company and Beilang Company. Diacatic acid fibrous membrane, hemophone, compound film, hollow fiber dialyser, bicarbonate dialysate, heparin （common heparin or low molecular heparin） anticoagulation were adopted. Volume of blood flow was 200-280 mL/min and volume of dialysate flow was 500 mL/min, twice or three times every week, 4-4.5 hours every time. Peritoneal dialysis tube was inserted by anatomy method in total peritoneal dialysis patients. Continuous ambulatory peritoneal dialysis （CAPD） was adopted. Double connected system of America Baite Company and dialysate containing glucose were applied. Patients name, sex, age, primary disease, blood urea nitrogen, creatinine （numerical value of fasting blood in the first time in the morning）, dialyzed manner were recorded to perform statistics and analysis. The relationship of etiological factor with age, sex and dialysis manner was analyzed. RESULTS： Totally 356 dialysis patients were involved in the result analysis. （1）Main etiological factor of ESRD patients were chronic glomerulonephritis （CGN） （52.0%）, followed by diabetic nephropathy （16.0%）, hypertensive nephropathy （13.2%）, and obstructive nephropathy （9.0%）. The ratio of male to female was 1.87 to 1, and the mean age was （51± 16） years. （2）Mean age of peritoneal dialysis patients was obviously higher than that of hematodialysis patients [（59± 15）, （50±16） years, P 〈 0.05]. 86.2% patients received hematodialysis, while 13.4% patients received peritoneal dialysis. The rate of choosing peritoneal dialysis was higher than that of hematodialysis in diabetic nephropathy patients （P 〈 0.01 ）. （~Connective tissue disorder （CTD） and CGN patients were younger, with an average of 40 years. Patients with hypertensive nephropathy, diabetic nephropathy, obstructive nephropathy, gout and multiple myeloma were older, about 95.0% over 40 years, with an average of 60 years, and there were significant difference as compared with the patients with chronic nephritis and lupus （P〈 0.05）. CONCLUSION： The patients are mainly middle and elder persons, mostly male. The key etiological factor of ESRD patients is CGN, followed by diabetic nephropathy. Peritoneal dialysis is the first choice for diabetic nephropathy.