高龄终末期肾衰竭病人不同治疗方式的临床疗效观察

Clinical efficacy of different treatment methods in elderly patients with end-stage renal failure

目的比较高龄(≥80岁)终末期肾衰竭病人采取不同治疗方式的临床疗效,探讨适合高龄终末期肾衰竭病人的治疗方式。方法收集本院5年间诊治的高龄终末期肾衰竭病人59例,其中18例采取单纯药物治疗,22例行常规血液透析(HD)治疗,19例以保留残余肾功能为目的进行低剂量透析治疗,比较3组间生命体征、血液生化指标、预后等指标的差异。结果治疗初期(6个月),常规透析剂量组和低透析剂量组在贫血、酸中毒、心功能的纠正和部分生活质量的改善方面优于单纯药物组(P<0.05),常规透析剂量组和低透析剂量组在残余尿量方面差异有统计学意义(P<0.05)。在治疗后期(24个月),低透析剂量组在残余尿量、生活质量方面优于单纯药物组和常规透析剂量组(P<0.05)。多脏器功能衰竭发生率及生存率3组间差异无统计学意义(P>0.05)。结论高龄终末期肾衰竭病人选择HD治疗应尽量保留残余肾功能,这有利于提高病人的生活质量。

Objective To explore the appropriate treatment methods for the elderly patients with end-stage renal failure.Methods A total of 59 elderly patients with end-stage renal failure diagnosed and treated in our hospital were collected.Eighteen cases were treated with medication alone,and 22 cases were treated with conventional hemodialysis,and 19 cases were treated with low-dose dialysis for the purpose of preserving residual renal function.The vital signs,blood biochemical indicators,prognosis and other indicators among the 3 groups were compared.Results At the initial stage of treatment(6 months),the conventional dialysis group and the low-dose dialysis group showed better effect than the drug group in terms of anemia,acidosis,heart failure correction and quality of life(P<0.05).There were significiant differences in residual urine volume between the conventional dialysis group and the low-dose dialysis group(P<0.05).In the later period of treatment(24 months),the low-dose dialysis group showed better effects than the drug group and the conventional dialysis group in terms of residual urine volume and quality of life(P<0.05).The incidence rate of multiple organ dysfunction syndrome(MODS)and the survival rate showed with no significantly statistic differences among the three groups.Conclusions The elderly patients with end-stage renal failure choose hemodialysis treatment should preserve the residual renal function as much as possible,which is conductive to impove the quality of life of patients.