持续非卧床腹膜透析慢性心功能不全患者再入院影响因素分析

Factors affecting the re-hospitalization due to chronic cardiac insufficiency in patients on continuous ambulatory peritoneal dialysis

目的探讨持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)慢性心功能不全患者6个月内再入院的危险因素。方法回顾性分析2017年1月~2018年12月在苏州大学附属第一医院肾内科腹膜透析中心的CAPD患者204例。采用Log-rank单因素分析和多因素Cox回归分析法,探讨CAPD慢性心功能不全患者再入院原因。结果 6个月内再入院人数为59例,占总人数的28.92%。2组患者在尿素氮、血清前白蛋白、收缩压、舒张压、容量管理水平和水肿程度方面存在统计学差异(x^2值分别为3.765,6.021,4.652,3.623,6.211,6.041;P值分别为0.017,0.001,0.015,0.018,0.001,0.001)。多因素COX回归分析示,容量管理水平、血清前白蛋白和水肿程度是CAPD慢性心功能不全患者6个月内再入院的危险因素(95%CI值分别为1.298~2.432,1.421~2.765,1.021~2.002;OR值分别为2.003,2.112,1.675;P值分别为0.023,0.001,0.034)。结论腹膜透析护士应提高CAPD患者的容量管理水平、改善营养状态和水肿程度,进而降低再住院率。

Objective To explore the risk factors for the re-hospitalization within six months due to chronic cardiac insufficiency in patients on continuous ambulatory peritoneal dialysis(CAPD). Methods We retrospectively analyzed 204 CAPD patients who were diagnosed chronic cardiac insufficiency from January 2017 to December 2018. Log-rank test for univariate analysis and Cox regression model for multivariate analysis were used to explore the cause of re-hospitalization due to chronic cardiac insufficiency in these CAPD patients. Results Re-hospitalization within six months happened in 59 cases with the recurrence rate of28.92%. There are statistically differences in blood urea nitrogen(x^2=3.765, P=0.017), serum pre-albumin(x^2=6.021, P=0.001), systolic blood pressure(x^2=4.652, P=0.015), diastolic blood pressure(x^2=3.623, P=0.018), volume management(x^2=6.211, P=0.001), edema degree(x^2=6.041, P=0.001) between the two groups. Multivariate Cox regression analyses showed that volume management(95% CI 1.298~2.432, OR=2.003, P= 0.023), serum pre-albumin(95% CI 1.421~2.765, OR=2.112, P=0.001) and edema degree(95% CI1.021~2.002, OR=1.675, P=0.034) were the risk factors for re-admission within six months in CAPD patients. Conclusion Nurses working for CAPD patients should increase their abilities in volume management,improvement of nutritional status and edema classification to reduce the re-admission rate.