老年维持性血液透析病人1年内死亡的原因及相关因素分析

Risk factors of death within 1 year in elderly patients undergoing maintenance hemodialysis

目的探讨老年维持性血液透析(MHD)病人开始透析后1年内死亡(透析后3~12月内死亡)的原因及相关影响因素。方法对2004年1月至2016年7月在我院维持性血液透析1年内死亡的34例老年病人(年龄≥60岁)的临床资料进行回顾性分析,分析其主要的死亡原因,对每1例死亡病例按1∶2匹配对照的方法选择与其同期开始MHD且生存时间超过12月的68例老年病人为对照组;采用单因素、多因素Logistic回归分析MHD死亡相关的危险因素。结果心脑血管疾病(58.82%)、感染(32.35%)为病例组的主要死因;年龄、合并糖尿病、合并有心脑血管疾病、高磷、透析不充分和透析间期体重增长过多是老年MHD病人1年内死亡的独立危险因素,而有效长期的透析前专科干预对老年维持性血液透析病人具有较好的保护作用。结论老年MHD病人1年内死亡的主要原因为心脑血管疾病,其次是感染。年龄、透析前出现心脑血管事件、合并糖尿病、高磷、透析不充分和透析间期体重增长过多与病人1年内死亡有关,透析前专科干预则可降低1年内死亡的风险。

Objective To explore the cause of death within 1 year （within 3-12 months after hemodialysis） and the related influencing factors of death in the elderly patients undergoing maintenance hemodialysis（MHD）. Methods A total of 34 elderly patients receiving MHD in our hospital who died within 1 years （age 60 years or more） were retrospectively analyzed from January 2004 to July 2016.68 elderly patients underwent hemodialysis in the same period （±2 months） and survived over 12 months were selected as control group. Logistic regression was used to analyze the related risk factors. Results Cardiovascular and cerebral vascular diseases （58.82%）, infection（ 32.35% ） were the main causes of death in the case group. Age, diabetes, combined with cardiovascular and cerebrovascular diseases, high phosphorus, inadequate dialysis and excessive weight gain during dialysis were independent risk factors for mortality in 1 years of MHD, and early specialist intervention before dialysis was a protective factor. Conclusions The main causes of death within 1 years in the elderly MHD patients are cardiac andcerebral vascular diseases, followed by infection. Old age, cardiovascular and cerebrovascular diseases, diabetes, high phosphorus, inadequate dialysis and excessive weight gain during dialysis are associated with the death of elderly patients within 1 years of MHD, and specialist intervention ahead of dialysis can reduce the risk of death within 1 years.