高龄慢肾衰患者维持性血透死因分析及对策

Clinical Analysis of Death Causes and Treatments Chronic Renal Failure in Old Patients Undergoing Maintenance Hemodialysis

目的对慢性肾功能衰竭维持性血液透析患者死亡原因进行回顾性分析,探讨其风险因素及预防。方法随机选择我院接受维持性血液透析1月以上死亡的慢肾衰患者41例及30例在院接受维持性血透患者为对照进行分析。结果心脏原因死亡18例,脑血管意外死亡8例,感染死亡12例,死亡组患者平均年龄高于对照组(P<0.001),平均血透时间短于对照组,血透期间体重增长率高于对照组,血清白蛋白浓度及红细胞压积低于对照组,因感染而死亡的患者血清白蛋白浓度及红细胞压积低于死亡组(P<0.001)。结论实验中心脏原因、肺部感染、脑血管意外为慢肾衰维持性血透患者最主要死亡原因,高龄、高血压、低蛋白血症、严重贫血和左心室肥厚是尿毒症患者维持性血透死亡的重要危险因素,积极控制透析患者的高血压、贫血、钙磷代谢及营养支持治疗,可提高患者生存率及生活质量,达到临床预防的目的。

Objective To identify the mortality-related factors and treatments in patients undergoing maintenance hemodialysis. Methods A total of 41 end-stage renal disease patients in our hospital who died of maintenance hemodialysis（group A） and 30 patients undergoing maintenance hemodialysis as control （ group B） were selected. Two groups data were analyzed with SPSS 10.0. Results The cardiac complications leading to death accounted for 18/41 ,infection and cerebrovascular accidents accounted for 12/41 and 8/41. The mean age in group A was more eider than that in group B ,The interdialysis weight increase in group A was higher than that in group B （ P 〈 0. 001 ）, but the levels of serum albumin and hematocrit in group A were much more lower than that in group B. The levels of serum albumin and hematocrit in patients with infection in group A were lower than those without infection in the same group（P 〈 0. 001 ）. Conclusions Cardiac complication was the leading cause of death in patients with maintenance hemodialysis in our hospital, the second cause of death was infection, and the third was cerebruvascular accident. The main risk factors of death include elder（ over 65 years old）, hypertension, hypoalbuminemia, severe anemia and left ventricle hypertrophy. We can decrease the mortality and develop life quantity if we controlled hypertension, hypoalbuminemia, severe anemia, calcium and phosphatic metablize, nutrition well.