腹膜透析患者退出原因分析

The cause of dropout in peritoneal dialysis patients

目的 调查腹膜透析患者退出的原因，为临床改善腹透预后提供依据。方法 分析随访持续性非卧床腹膜透析（CAPD）病人145例，统计退出患者例数，调查其退出原因，同时评估营养状况、透析充分性、容量负荷指标。结果 145例腹膜透析患者中64例退出，占腹透总数44．1％。其中死亡40例（62．5％），余为改血液透析，肾移植或因经济困难放弃治疗患者。退出原因中，心脑血管疾病占首位34例（53．1％）；顽固性腹膜炎10例（15．6％），余为超滤衰竭，严重营养不良，极少数为胸腔积液，恶性肿瘤，腹透漂管退出腹透。在死亡患者中，心脑血管急症如心衰、心梗、脑出血等构成了主要死因（51．6％），其次依次为严重感染如肺炎、腹膜炎、败血症（20．1％）呼吸衰竭；多器官功能障碍；消化道出血；恶性肿瘤及放弃治疗。死亡组较存活组具有更明显的营养不良、容量负荷过重及透析不充分，两组间有统计学差异（P〈0．05）。结论 脑血管事件是CAPD患者死亡退出的最主要原因。炎症感染，包括腹腔外感染是PD中断及预后不良的重要因素之一。经济原因一定程度上制约腹透的开展与维持。营养不良、容量超负荷、透析不充分与心脑血管并发症及腹透患者退出率、死亡率呈正相关。

Objective： To investigate the cause of dropout in patients with continuous ambulatory peritoneal dialysis （CAPD）. Methods： 145 CAPD patients were enrolled.Their dropout were reviewed .Nutritional status, dialysis sufficency,and volume load were also evaluated Results： 64 patients were dropout（44.1%）.40 of the 64 （62.5%） patients died,and the other were turned to hemodialysis ,kidney transplantation or give up because of financial straits.The main causes of dropout were cardiac-cerebral vascular disorder （CVD）（53.1%） and infectious disease （15.6%）.The other causes were ultrafiltration failure, malnutrition, pleural effussion and malignant tumor. 51.6% patients＇ death were due to congestive heart failure, heart infarction or apoplexy.And 20.1% patients died of infectious disease such as pneumonia, peritonitis, septicaemia. Respiratory failure,MOSF, alimentary tract hemorrhage, malignant tumor were also the causes of death in CAPD patients.The patients with malnutrition,volume overload and dialysis insufficency had significantly lower survival rate as compared with those without these problems. （P〈 0. 05）. Conclusion： CVD were the most common causes of death in CAPD patients . Infection can contributed to the poor outcome of patient. Economics status limited PD carrying out in some extent. Malnutrition ,volume overload and dialysis insufficency had a great effct on the dropout and death rate of CAPD patients.