血液透析和腹膜透析对终末期肾病患者预后的影响及其安全性比较

Comparison of the Prognosis and Safety of Patients with End-stage Renal Disease Undergoing Hemodialysis and Peritoneal Dialysis

目的:分析和比较血液透析和腹膜透析终末期肾病患者预后的影响及其安全性。方法:选取2010年1月至2016年4月本医院收治的透析患者246例作为研究对象,将其分为血液透析组和腹膜透析组,比较两组患者治疗后的生存情况及并发症的发生情况。结果:两组患者死亡原因是心力衰竭、消化道出血、重度感染、脑梗死,两组的病死率及死因构成比较差异均无统计学意义(P>0.05)。腹膜透析组患者1年、3年、5年生存率均显著高于血液透析组(P<0.05),两组患者7年生存率比较差异无统计学意义(P>0.05)。首次透析年龄超过60岁的终末期肾病患者中,腹膜透析组1年、3年、5年、7年生存率均显著低于血液透析组(P<0.05)。血液透析组心力衰竭、动静脉内瘘闭塞发生率显著高于腹膜透析组(P<0.05),腹膜透析组腹膜炎的发生率显著高于血液透析组(P<0.05),血液透析组总并发症发生率明显高于腹膜透析组(P<0.05)。结论:血液透析和腹膜透析各有优缺点,对终末期肾病患者应个体化选择透析方式,减少并发症,提高生活质量及生存率。

Objective： To compare the effect of hemodialysis and peritoneal dialysis on the prognosis and safety of patients with end-stage renal disease（ESRD）. Methods： 246 patients with dialysis in our hospital from January 2010 to April 2016 were selected and divided into two groups： hemodialysis group and peritoneal dialysis group, the survival and incidence of complications were compared between the two groups. Results： The causes of death in both groups were heart failure, gastrointestinal bleeding, severe infection, cerebral infarction, and the fatality rate and cause of death showed no statistically significant difference（P〈0.05）. The 1-year, 3-year and5-year survival rates of ESRD patients in the peritoneal dialysis group were significantly higher than those of the hemodialysis group（P〈0.05）, no statistical difference was found in the 7-year survival rate between two groups（P〈0.05）. For the first time in over 60 years of age in patients with end-stage renal disease, the 1-year, 3-year, 5-year and 7-year survival rates were significantly lower than those of the hemodialysis group（P〈0.05）. The incidence of heart failure, arteriovenous fistula occlusion of hemodialysis group were higher than those of the peritoneal dialysis group（P〈0.05）, the incidence of peritonitis in peritoneal dialysis group was higher than that of the hemodialysis group（P〈0.05）, the total complication rate in the hemodialysis group was higher than that of the peritoneal dialysis group（P〈0.05）. Conclusion： Hemodialysis and peritoneal dialysis had their own advantages and disadvantages, we should choose the mode of dialysis for patients with end-stage renal disease, reduce the complications, improve the quality of life and the survival rate.