血液透析患者猝死原因的临床分析

目的:分析血液透析患者猝死的相关性因素,以更好的防治血液透析患者的猝死。方法:回顾血液透析室具有完整病历资料的死亡患者57例,其中猝死18例,对比分析猝死患者(猝死组)和其他死亡患者(非猝死组)死亡前3个月的临床、实验室相关资料及回访1年内的心脏彩超结果,以猝死为因变量对上述资料进行逐步多元回归分析。结果:维持透析时间长短、死亡前1个月的平均透析前血压控制情况、透析间期体重及平均每次超滤量猝死组均高于非猝死组、每周透析时间<8小时、高钾血症及合并糖尿病在猝死组的比例显著高于非猝死组。猝死组与非猝死组之间的比较,P值<0.05差异有统计学意义,与血液透析患者的猝死有关。糖尿病、维持透析时间、透析前血压增高、每周透析时间<8小时、透析间期体重增加过多、高钾血症是血液透析患者猝死的独立危险因素。结论:维持透析时间长、合并糖尿病、透析间期体重增加过多、血压控制差及透析不充分是血液透析患者猝死的危险因素。

Objective：To analyse the cause of sudden death in hemodialysis patients, and prevention and controll sudden death. Meth- ods：A retrospective analysis of our hemodi- alysis room 4years, with more complete med- ical records of 57 cases of patients, which meet the standards of the 18 cases of sudden death. Comparative Analysis of sudden death （SD group）and other patients who died （non - sudden death group ） died before 3 months of clinical,laboratory data and death of the fist 1 year of echocardiography re- sults. To sudden death as the dependent var- iable on the clinical data stepwise multiple regression analysis. Results：Sudden death inpatients ! month before death, the average blood pressure before dialysis, the average for each ultrafihration dialysis and maintain dialysis time were significantly higher than non - sudden death group. Sudden death in patients with diabetes, the weekly dialysis time was less 8 hours and hyperkalemia, sig- nificantly higher than the proportion of pa- tients with non - sudden death group. Multi- ple regression analysis showed that diabetes mellitus,blood pressure increased, the aver- age dialysis ultrafiltration, maintain dialysis time, and less than 8 hours per week dial- ysied was hemodialysied patients with risk factors for sudden death. Conclusions： Dia- betes, long maintain dialysis time, poor blood pressure control, volume overload, and inadequate dialysis are hemodialysis patients risk factors for sudden death.