尿毒症老年血液透析患者死亡相关因素分析

Analysis of Related Factors of Death in Elderly Hemodialysis Patients with Uremia

目的:探究尿毒症老年血液透析患者死亡相关因素。方法:选取经3~24个月血液透析后死亡的21例尿毒症血液透析老年患者作为死亡组,同期进行血液透析且生存时间超过24个月的168例尿毒症血液透析老年患者作为对照组;回顾性分析两组患者的临床资料,了解尿毒症老年血液透析患者死亡相关因素,探究尿毒症血液透析老年患者生存状况的影响因素。结果:死亡组患者中9例(42.8%)死因为心血管事件,5例(23.8%)死因为脑血管意外,心血管事件和脑血管意外为尿毒症血液透析老年患者的主要死因;单因素分析结果显示,年龄、合并症、透析前肾小球滤过率(e GFR)、全段甲状旁腺激素(i PTH)、低密度脂蛋白胆固醇(LDL)、C-反应蛋白(CRP)、查尔森合并症指数(CCI)、透析后尿素氮下降(Kt/V)、每周透析时间、透析前肾脏专科随诊与尿毒症血液透析老年患者生存状况有一定的相关性(P<0.05);多因素Logistic分析结果显示,透析前e GFR、LDL、CRP和Kt/V为尿毒症血液透析老年患者生存状况的独立危险因素(P<0.05)。结论:高龄、存在合并症、透析前高e GFR和CRP、透析前低LDL、Kt/V>1.2、透析前无肾脏专科随诊的尿毒症血液透析老年患者的生存状况较差,应加强对患者的监控,提高生存率。

Objective： To investigate related factors of death in elderly hemodialysis patients with uremia. Methods： 21 elderly patients （deceased） with uremia accepted hemodialysis for 3 -24 months as death group, and at the same period 168 cases accepting in hemodialysis with the survival time more than 24 month as control group. Retrospective analysis of clinical data of patients to explore influencing factors of death related factors and survival status in hemodialysis patients. Results： 9 cases in death elderly uremia hemodialysis patients; single factor analysis indicated that uremia hemodialysis patients survival status was correlated with age, complication, glomerular filtration rate （ eGFR）, the entire section before parathyroid hormone （ iPTH）, low density lipoprotein cholesterol （ LDL）, C-reactive protein （CRP）, check coulson complications index （CCI）, urea nitrogen decreased after dialysis （ Kt/V）, weekly dialysis time, nephrology specialist clinic visits before dialysis （ P 〈 0.05 ） ; Muhiari- able Logistic analysis results showed that eGFR before dialysis, LDL, CRP and Kt/V were for living conditions of the independent risk factors patients with uremia hemodialysis（ P 〈 0.05 ）. Conclusions： Age, complications before dialysis, high eGFR and CRP before dialysis, low LDL and Kt/V 〉 1.2 before dialysis, none nephrology specialist visited elderly patients would lead to poor survival status, it is suggested to strengthen the monitoring of patients in order to improve the survival rate.