中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (11): 595-599.doi: 10.3969/j.issn.1671-4091.2016.11.004

• 临床研究 • 上一篇    下一篇

166例腹膜透析患者腹膜透析情况问卷调查和腹膜透析相关性腹膜炎危险因素

左晶晶,任红,徐天,黄晓敏,张春燕,杨丽   

  1. 上海交通大学医学院附属瑞金医院肾脏科
  • 收稿日期:2016-05-09 修回日期:2016-09-13 出版日期:2016-11-12 发布日期:2016-11-12
  • 通讯作者: 任红 renhong66@126.com E-mail:zjjup2014@163.com
  • 基金资助:

    国家自然科学基金青年项目(81300633),上海市卫生局青年项目(20134Y101),项目基金国家重点基础研究发展计划(2012CB517604), 卫生行业科研专项项目(201002010), 科技部十二五科技攻关项目 (2011BAI10B06),上海市自然科学基金(15ZR1426300)

Peritoneal dialysis investigation of 166 cases and research on factors for PD-related peritonitis

  • Received:2016-05-09 Revised:2016-09-13 Online:2016-11-12 Published:2016-11-12

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摘要： 目的  调查维持性腹膜透析患者的受照顾情况、卫生情况、生活质量和家庭经济状况，探讨腹膜透析患者发生腹膜炎的危险因素。方法对上海瑞金医院腹膜透析中心166 例稳定透析、随访规律、腹膜透析时间＞3 个月的维持性腹膜透析患者展开问卷调查。结合患者的相关临床资料，包括实验室检查结果、腹膜透析随访评估和腹膜炎发生率，进行相关统计分析寻找腹膜炎危险因素。结果166 例腹膜透析患者中男性占103 例(62.4%)，初始透析年龄平均为(57.88±17.31)岁，至2015 年12 月底期间曾发生腹膜炎者达55 人(33.13%)。经LOGISTIC 回归模型分析提示,发生腹膜炎的危险因素是年龄(OR=1.054，95% CI 1.007～1.104，P=0.025)、血25-羟基维生素D3水平(P=0.033,95% CI 1.003～1.090，OR=1.045)、花费对家庭影响(OR =0.371，95% CI 0.149～0.923，P=0.037)。腹膜炎组与非腹膜炎组相比，透析龄更长(Z=-6.796, P＜0.001)，尿素清除指数(kt/v) (Z=-2.174, P=0.030)、内生肌酐清除率(endogenous creatinine clearance rate, CCR)值更高(Z=-2.286, P=0.022)，患者参与社会工作学习的比率更高(P=0.037)。结论本研究中腹膜透析患者的受照顾情况、卫生情况、生活质量基本良好，腹膜透析花费对大部分家庭处于可接受水平；腹膜透析患者初始透析年龄大、透前25-OH-D3 较高是腹膜炎发生的高危因素，主观认为腹膜透析支出对家庭经济影响大者腹膜炎发生率低；社会生活的高参与度(患者能正常参与社会工作学习)、透析龄长、腹膜透析溶质清除不足等也可能影响腹膜炎发生。

关键词: 腹膜透析, 腹膜炎, 问卷调查

Abstract: Objective To investigate the family caring support,the environment and sanity,the life quality and family economic burden to afford the medical expenses of peritoneal dialysis patients,we discussed about the risk factors for peritonitis taking place in patients accepting peritoneal dialysis. Method Questionnaire
on peritoneal patients who ungerwent the peritoneal dialysis in our center for at least 3 months and followed up steadily with regularly evaluating results for their dialysis effects.Combined with the patients' personal clinical information,including the results of experimental tests,the follow-up evaluation on dialysis,and the total occurence of peritonitis,related statistics were analyzed to find out risk factors for peritonitis.Results Among the 166 PD patients,103 cases were males(62.4%),the average age at the beginning of PD was 57.88±17.31 years.Up to December 2015, totally 55 cases(33.13%) went on peritonitis in the observing period.LOGISTIC proportional hazards model analysis indicated that the risk factors for peritonitis were ：age at the beginning of PD (OR=1.054，95% CI 1.007～1.104，P=0.025),high blood level of 1,25-OH-D3(P=0.033, 95%CI: 1.003～1.090，OR=1.045),and the influence of PD expenditure on family economics (OR=0.371，95% CI 0.149～0.923，P=0.037). Compared with the non-peritonitis,the peritonitis group had longer duration of peritoneal dialysis (Z=-6.796，P＜0.001),higer value of kt/v and CCR (Z=-2.174，P=0.030),and higher rate of involvement in social work and study (Z=-2.286，P=0.022). Conclusion In the PD patients treated in our center, family caring support, environment and sanity, and quality of life were basically in good conditions, and medical expenses
were acceptable to most PD families. Older age at the beginning of PD, higher plasma 1,25-OH-D3 before PD were the risk factors for PD-related peritonitis. The peritonitis rate was relatively lower in the families considering PD as a big financial burden. More involvement in social work or study, longer PD duration, and insufficient clearance of toxic solutes also contributed to the presence of peritonitis.

Key words: petironeal dialysis, peritonitis, Investigation