探讨终末期肾病患者用腹膜透析与血液透析两种紧急透析方式治疗的相关并发症和患者生存率

Complications and Survival of Patients with End-stage Renal Disease Treated with Two Emergency Dialysis Modali⁃ties,Peritoneal Dialysis and Hemodialysis

目的:探讨终末期肾病(ESRD)患者用腹膜透析(PD)与血液透析(HD)两种紧急透析方式治疗的相关并发症和患者生存率。方法:回顾性收集2016年1—10月于广西壮族自治区桂东人民医院收治的190例ESRD患者的病例资料进行分析,根据透析方案将其分为PD组和HD组,其中60例PD组患者采用低钙透析液和美国Baxter公司双联双袋系统行透析治疗,根据腹膜平衡试验、腹透超滤量完成针对性透析治疗;130例HD患者应用常规碳酸氢盐血液透析方法开始透析,比较两组患者透析7~35个月期间并发症的发生情况。所有患者自开始透析后均进行随访,随访至2020年12月或至患者死亡,记录两组患者生存情况。结果:PD组透析期间心力衰竭、动静脉瘘、消化道出血、闭塞性腹膜炎以及感染等总并发症发生率低于HD组,差异有统计学意义(χ^(2)=5.037,P<0.05);两组患者开始透析后均进行随访,随访至2020年12月或至患者死亡,随访时间为5~57个月,中位随访时间为48个月,随访期间HD组、PD组死亡率分别为30.00%(39/130)、13.33%(8/60),PD组4年总生存率高于HD组,差异有统计学意义(χ^(2)=6.125,P<0.05),经Lon-rank检验发现两组患者生存曲线差异有统计学意义(χ^(2)=8.230,P<0.001)。结论:与HD相比,PD紧急透析方式治疗能减少ESRD患者并发症发生情况,提高生存率。

Objective:To investigate the complications and survival rates of patients with end-stage renal disease(ESRD)treated with emergency dialysis(PD)and hemodialysis(HD).Methods:The case data of 190 ESRD patients admitted to the hospital from January 2016 to October 2016 were retrospectively collected for analysis,and they were divided into PD group and HD group ac⁃cording to the dialysis program.The 60 patients in the PD group were treated with low calcium dialysate and the dual-double-bag system of Baxter in the United States,and the targeted dialysis treatment was completed according to the peritoneal balance test and the ultrafiltration volume of peritoneal dialysis.Dialysis was initiated in 130 HD patients using conventional bicarbonate hemodialysis.The complications of the two groups during the period of 7-35 months were compared.All patients were followed up after they started dialysis,and they were followed up until December 2020 or until the patients’death,and the survival of the two groups of patients was recorded.Results:The incidence of total complications such as heart failure,arteriovenous fistula,gastrointestinal bleeding,obliterative peritonitis and infection during dialysis in PD group was lower than that in HD group,and the difference was statistically significant(χ^(2)=5.037,P<0.05).Both groups of patients were followed up after they started dialysis,and were followed up until December 2020 or until the patients’death.The follow-up time was 5-57 months,and the median follow-up time was 48 months.During the follow-up period,the mortality rates of HD group and PD group were 30.00%(39/130)and 13.33%(8/60).The 4-year overall survival rate of PD group was higher than that of HD group,and the difference was statistically significant(χ^(2)=6.125,P<0.05).The Lon-rank test showed that there was statistically significant difference in the survival curves between the two groups(χ^(2)=8.230,P<0.001).Conclusion:Compared with HD,emergency dialysis treatment of PD can reduce the incidence of complications and improve the survival rate of ESRD patients.