老年维持性血液透析患者第1年内的生存状况调查

The survival and functional status of the aged patients during the first year after initiation of hemodialysis

目的 观察老年维持性血液透析（maintenance hemodialysis,MHD）患者在开始透析的第1年生存及日常生活活动能力变化.方法 调查2009年7月1日至2011年6月30日于首都医科大学附属复兴医院开始行MHD的老年患者（年龄≥65岁）第1年内的生存状况.应用日常生活活动 （activities of daily living,ADL）量表（Barthel指数）对患者日常生活活动能力评分,动态观察首次透析时、透析后3、6和12个月的评分变化.对照组为同期开始透析的年龄在18～65岁的患者.结果 研究期内开始透析的MHD患者51例,老年组38例,占75%,非老年组13例.2组患者首次透析的指标除年龄和性别比例有差别外,其他如合并症、估计的肾小球滤过率（estimated glomerular filtration rate,eGFR）、血白蛋白（albumin,Alb） 以及血红蛋白（hemoglobin,Hb）比较,差异均无统计学意义.随访期间转出4例（老年组2例,非老年组2）,死亡16例,死亡患者均来自老年组.死亡原因主要为感染和心脑血管疾病.首次透析时,老年组的ADL评分明显低于非老年组（P〈0.01）.随访12个月时,老年组20例患者中2例ADL评分降低,其余患者均维持不变或好转.其中15例患者评分为轻度功能障碍或正常,日常生活基本或完全自理.结论 老年患者是新入MHD患者的主要人群.他们在开始透析后1年内特别是3个月内死亡风险明显高于非老年组,感染和心血管疾病是主要死因.1年内存活的老年患者绝大部分能够维持基本正常的日常生活活动能力.

Objective To evaluate the survival and functional status of the aged patients during the first year after initiation of hemodialysis. Methods Incident patients with end stage of renal disease starting hemodialysis between 1 July 2009 and 30 June 2011 were included in the study. The clinical data of the aged patients（ I〉65 years） and non-elderly patients（ 18 -65 years） were collected. Activities of daily life （ADL） scores were measured at the initiation of dialysis and at 3,6,12 months after the initiation of dialysis. Results A total of 51 patients were included in this study. Elderly MHD patients accounted for 75%. There were no difference in complications, the levels of eGFR, serum albumin and Hb （ P 〉 0. 05 ）. Sixteen patients in the elderly group died during the first year. The main causes of death contain infection, cardiovascular and cerebrovascular disease. At the first time of dialysis, the ADL scores of the aged patients were significantly lower than those of the non-elderly patients （P 〈 0. 01 ）. Twelve months after the initiation of dialysis, the ADL scores had been maintained in 90% of the 20 surviving patients in the aged group. Conclusion The aged patients account for the main population of ESRD patients initiating hemodialysis. Higher mortality rates were seen in the aged HD patients in the first year, especially in the first 3 months of treatment. The main causes of death contain infection and cardiovascular disease. The ADL scores of 90% of the aged group had been maintained during the first year after initiation of hemodialysis.