血液透析对中老年患者血生化指标的影响及并发症研究

Study on the influence of hemodialysis on blood biochemical indexes and complications in middle-aged and elderly patients

目的研究血液透析对中老年患者血生化指标的影响及并发症。方法选取自贡市第四人民医院肾脏内科2019年9月~2022年9月行维持性血液透析的患者747例,根据患者年龄分为中年组(年龄45~59岁,n=170)、老年组(年龄≥60岁,n=577),两组患者均接受维持性血液透析治疗,对比两组的透析充分性、透析前后生化指标(谷丙转氨酶、谷草转氨酶、总胆红素、尿酸、血肌酐、尿素氮、血胆固醇、三酰甘油、血糖、脑利钠肽)、血常规指标(血红蛋白、白细胞、血小板、红细胞计数、血纤维蛋白)变化情况,同时对比两组中并发症(感染、血栓、低血压、低蛋白血症、消化道出血、动静脉内瘘闭塞)发生率、透析后转归情况以及生存时间。结果透析后,中年组的尿素下降率(URR)高于老组,差异有统计学意义(P<0.05);中年组谷丙转氨酶、谷草转氨酶、总胆红素、尿酸、血肌酐、尿素氮、血胆固醇、三酰甘油水平均低于老年组,差异有统计学意义(P<0.05);而两组的血糖、脑利钠肽水平对比差异无统计学意义(P>0.05)。中年组的血红蛋白、血小板、红细胞计数均高于老年组,其白细胞、血纤维蛋白水平低于老年组,差异有统计学意义(P<0.05)。透析过程中,中年组的并发症发生率低于老年组,死亡率低于老年组,生存时间长于老年组,差异有统计学意义(P<0.05)。结论老年患者的透析充分性较中年患者略差,且患者年龄越大对血液透析后的血生化指标影响就越大,且相较于中年人,老年人在透析过程中的并发症发生率较高,转归情况较差,生存时间短。

Objective To study the influence of hemodialysis on blood biochemical indexes and complications in middle-aged and elderly patients.Methods A total of 747 patients receiving maintenance hemodialysis in the department of nephrology Zigong Fourth People′s Hospital from September 2019 to September 2022 were selected as the research objects.According to the age of the patients,they were divided into the middle-aged group(170 patients aged 45~59 years old)and the elderly group(577 patients aged≥60 years old).Both groups received maintenance hemodialysis treatment.The changes of dialysis adequacy,biochemical indexes(alanine aminotransferase,aspartate aminotransferase,total bilirubin,uric acid,serum creatinine,urea nitrogen,blood cholesterol,triglycerides,blood glucose,brain natriuretic peptide),and routine blood indexes(hemoglobin,white blood cells,platelets,red blood cell count,and blood fibrin)before and after dialysis were compared between the two groups.At the same time,the incidence of complications(infection,thrombosis,hypotension,hypoproteinemia,gastrointestinal bleeding,arteriovenous fistula occlusion),outcomes after dialysis and survival time in the two groups were compared.Results After dialysis,URR of the middle-aged group was higher than that of the old group(P<0.05).The levels of alanine aminotransferase,aspartate aminotransferase,total bilirubin,uric acid,serum creatinine,urea nitrogen,blood cholesterol and triglyceride in the middle-aged group were lower than those in the elderly group(P<0.05),but there was no significant difference in blood glucose and brain natriuretic peptide levels between the two groups(P>0.05).The counts of hemoglobin,platelet and red blood cell in middle age group were higher than those in old age group,while the levels of white blood cell and blood fibrin in middle age group were lower than those in old age group(P<0.05).During dialysis,the complication rate of the middle-aged group was lower than that of the elderly group,the mortality rate was also lower than that of the elderly group,and the survival time was longer than that of the elderly group(P<0.05).Conclusion The dialysis adequacy of elderly patients is slightly worse than that of middle-aged patients,and the older the patient is,patients show the greater the influence on the blood biochemical indexes after hemodialysis.Moreover,compared with middle-aged people,the elderly have a higher incidence of complications during dialysis,poor outcome and shorter survival time.