持续性非卧床腹膜透析患者119例死亡原因分析

The dead causes of 119 continuous ambulatory peritoneal dialysis patients

目的 分析持续性非卧床腹膜透析（CAPD）患者的死亡原因,为延长患者生存时间提供依据.方法 回顾性分析119例CAPD患者的死亡原因,并与同期126例CAPD存活患者相比较,以寻找其死亡的高危因素.结果 心血管并发症、脑血管意外和营养不良是最主要的死亡原因,分别占30.3%、24.4%和16.8%.与存活组相比,死亡组的年龄、动脉血压（收缩压和舒张压）、胆固醇和C反应蛋白升高（P〈0.05或P〈0.01）,死亡组左心室肥大的比例升高（P〈0.01）,而心脏射血分数、血红蛋白、血浆白蛋白、主观综合性营养评估、尿素氮清除率、透析前残余肾功能和透析前尿量降低（P〈0.01）.结论 心脑血管并发症和营养不良是CAPD患者最主要的死亡原因,与残余肾功能减退、左心室肥大、高血压、蛋白质丢失和微炎症等因素有关.保护残余肾功能、积极有效地控制高血压、纠正营养不良和减少腹膜炎的发生率将有助于延长患者生存时间,降低死亡率.

Objective To analyze the dead causes of continuous ambulatory peritoneal dialysis （CAPD） patients. Methods The dead causes of 119 CAPD patients were analyzed retrospectively. The relative factors between the dead group and the survival group containing 126 survival patients re- ceiving peritoneal dialysis in the same period were compared to find out the high risk factors for the death. Results Cardiovascular complications, cerebrovaseular accidents and malnutrition were the main causes of death, accounting respectively for 30. 3%, 24. 4% and 16. 8%. As compared with the survival group, the age, arterial blood pressure （systolic blood pressure and diastolic blood pressure）, total cholesterol （TC） and C-reactive protein （CRP） were increased in death group （P〈0. 05 or P〈 0. 01）. The proportion of left ventricular hypertrophy was higher in death group than in the survival group （P〈0. 01）. The ejection fraction （EF）, hemoglobin （Hb）, plasma albumin （Alb）, the subjective global assessment （SGA）, blood urea nitrogen clearance （Kt/V）, residual renal function （RRF） before peritoneal dialysis and urine volume before peritoneal dialysis were decreased in the death group as compared with the survival group （P〈0. 01）. Conclusions The cardiovascular and cerebrovascular complications and malnutrition were the main causes of deaths in maintenance peritoneal dialysis patients, which was related with the loss of residual renal function, left ventricular hypertrophy, poor control of hypertension, the loss of albumen, and inflammation. Therefore, it can prolong the survival and reduce the mortality by protecting residual renal function, actively controlling hypertension, correcting malnutrition and reducing the incidence of peritonitis.