40例在院退出腹膜透析患者的相关临床分析

A Correlative Analysis of the Dropout in 40 Peritoneal Dialysis Patients in the Hospital

目的:调查我院腹膜透析患者死亡和转HD治疗的原因及相关影响因素。方法:收集腹膜透析患者在我院死亡14例,转HD治疗2 6例;查阅40例患者在我院的完整病历资料,调查其死亡及转HD治疗的原因及感染病原菌、营养等指标。结果:14例腹膜透析死亡患者主要原因为肺部感染合并心脑血管疾病及消化道出血,均占(29%,4/14)。64.3%(9/14)的死亡患者HB<90 g/L,ALB<30 g/l;71.4%(10/14)的腹膜透析死亡患者合并钙磷失调。26例腹膜透析患者转HD的首要原因和次要原因分别为腹透相关性腹膜炎(50%,13/26)和透析液引流不畅(42%,11/26)。72.7%透析液引流不畅的腹透患者经影像学诊断漂管,27.3%患者为拔管手术证实网膜堵塞管口。结论:1.肺部感染性疾病合并合并心脑血管系统及消化系统,为腹膜透析患者死亡的主要原因,与全身营养状况不良,钙磷失调有关。2.腹膜透析相关性腹膜炎仍为腹膜透析患者退出转HD治疗的主要原因。3.因透析液引流不畅而拔管为转HD治疗的第二位原因,漂管和网膜阻塞管口为透析液引流不畅的原因。

Objective：To analyze the cause of death and conversion HD therapy and correlative factors in peritoneal dialysis patients in West China Hospital.Methods：Fourty peritoneal dialysis patients,14 patients of whom were dead,26 patients of whom convert to HD therapy,were enrolled.The complete case history of the patients were reviewed,the cause of death and conversion HD therapy,infection-associated pathogenic bacteria and Nutritional status etc were evaluated.Results：The main cause of death were pulmonary infection with cardiac-cerebral diseases（29%,4/14）,pulmonary infection with gastrointestinal bleeding（29%,4/14）.64.3%（9/14） PD patients who were dead had malnutrition（HB〈90G/L,ALB〈30G/L）.71.4%（10/14） PD patients who were dead incorporated calcium and phosphate metabolism disturbance.The fist cause of conversion HD therapy was PD related peritonitis（50%,13/26）,the secondary cause was dialysis fluid inadequate drainage（42%,11/26）.72.7%（8/11） of whom was diagnosed catheter shift by image method,27.3%（3/11） of whom was validated net membrane wall up catheter by pull pipe operation.Conclusion：1.Pulmonary infection diseases incorporation cardiac-cerebral diseases and digestive system were major death cause in PD patients,as well as,correlated with malnutrition and calcium and phosphate metabolism disturbance.2.Peritoneal dialysis related peritonitis was still the main cause of conversion HD therapy in PD patients.3.Dialysis fluid inadequate drainage,the cause of which were catheter shift and net membrane wall up catheter,was the secondary cause inducing conversion HD therapy after operation.