老年血液透析患者的临床特点分析

Clinical Characteristic Analysis of Elderly Patients Undergoing Hemodialysis

目的研究老年血液透析患者的临床特点,探讨如何控制老年血液透析患者的并发症,以提高其生活质量,减少病死率。方法对2013年1月-2014年1月期间98例行维持性血液透析的尿毒症患者(分为老年组41例和中青年组57例)的临床资料进行对比分析,并前瞻性观察1年,对其并发症、住院率、病死率情况进行分析。结果老年组患者中高血压肾病及糖尿病肾病患者所占比例高于中青年组,带涤纶套半永久性颈静脉导管使用率较中青年组高;老年组患者血红蛋白、血浆白蛋白、血清肌酐均低于中青年组,C反应蛋白高于中青年组,差异有统计学意义(P<0.05);两组总胆固醇、三酰甘油、钙、磷、甲状旁腺激素差异无统计学意义(P>0.05),尿素氮清除率(KT/v)低于中青年患者,差异有统计学意义(P<0.05)。在1年的随访观察中,老年组在透析中低血压、血管通路血流不畅发生率、住院率、病死率高于中青年组,差异有统计学意义(P<0.05)。结论改善营养状况、保持血管通路长期通畅、减少透析并发症是提高老年维持性血液透析患者的生活质量、降低病死率的关键。

Objective To study the clinical characteristics of elderly hemodialysis（HD） patients and discuss how to control their complications, in order to improve their quality of life and lower their mortality rate. Methods Contrastive study and analysis were performed on the clinical data of 98 maintenance HD patients（between elderly and young HD patients） between January 2013 and January 2014. Complications, rate of hospitalization and mortality were analyzed during the follow-up of one year. Results The ratio of hypertensive kidney disease and diabetic nephropathy, as primary disease of the elderly HD patients, gradually increased. More people chose to use semipermanent jugular vein catheter for elderly HD patients. Compared with young HD patients, the levels of hemoglobin, albumin, serum creatinine, KT/v were lower in the elderly patients, and C-reactive protein was much higher（P〈0.05）. There was no significant difference in cholesterol, triglyceride, calcium, phosphorus, parathormone between the two groups（P〉0.05）. Dialysis-related hypotension and blocking of vascular access occurred more frequently in elderly HD patients. Hospitalization rate and mortality rate were higher in elderly HD patients（P〈0.05）. Conclusion Improving nutritional status, keeping vascular access unobstructed for a long time and decreasing complications related to hemodialysis are helpful for elderly HD patients to enhance their quality of life and reduce the mortality rate.