中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (02): 107-109.

• 短篇论著 • 上一篇    下一篇

维持性血液透析患者住院及死亡事件分析

蒲蕾1,何强2,洪大情3,吴姝焜4,邓菲5,王芳6,李贵森6,王莉3   

  1. 1. 四川省医学科学院，四川省人民医院
    2. 四川省医学科学院·四川省人民医院
    3. 四川省人民医院
    4. 四川省医学科学院 四川省人民医院
    5.
    6. 四川省医学科学院•四川省人民医院肾内科
  • 收稿日期:2012-07-23 修回日期:2012-10-07 出版日期:2013-02-12 发布日期:2013-02-12
  • 通讯作者: 王莉 E-mail:scwangli62@163.com

study the hospitalization and deaths of maintenance hemodialysis patients

  • Received:2012-07-23 Revised:2012-10-07 Online:2013-02-12 Published:2013-02-12

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摘要： 【目的】：分析在我科透析中心行维持性血液透析治疗患者住院及死亡情况，及影响维持性透析患者住院及死亡事件发生的危险因素。【方法】：纳入自2010年8月~2011年12月在我科透析中心行维持性血液透析治疗三月以上的患者共310名，登记其在此期间住院及死亡事件的发生情况。以患者住院和/或死亡作为不良事件，分析下列指标与不良事件发生的相关性，包括：性别，年龄，HD病程，BMI，血压， CRP，总胆固醇，甘油三脂，高密度脂蛋白，低密度脂蛋白，kt/v, 白蛋白，血红蛋白，钙化评分，PTH，钙，磷。均数间比较使用t检验，logistic多元回归分析住院及死亡的影响因素。【结果】：1）观察期间共有106名患者发生了146人次住院，住院率为1059住院次/1000病人年。导致患者住院前三位的原因是：感染（45.8%），心脑血管并发症（22.6%），血管通路问题（8.9%）。2）观察期间共有30名患者死亡，死亡率为69人/1000病人年。导致患者死亡第一位的原因为心脑血管事件（56.6%），其次为感染相关死亡（23.3%）。3）最终208名患者纳入危险因素分析。不良事件发生组年龄及血管钙化水平明显高于无终点事件组（p＜0.01），血浆白蛋白及血红蛋白水平明显低于无终点事件组（p＜0.01）。多元回归分析提示：患者年龄大、低血浆白蛋白水平、低血红蛋白水平是透析患者发生不良事件的独立危险因素（OR值分别是1.037，0.899，0.980）。【结论】：维持性血液透析患者住院及死亡的发生率高，感染及心脑血管事件是患者住院及死亡的前两位原因。年龄大，低血红蛋白及低血浆白蛋白水平是患者不良事件发生的独立危险因素。

关键词: 维持性血液透析, 住院, 死亡, 危险因素

Abstract: [objective] to analyze the occurrence of hospitalization and deaths of the maintenance hemodialysis patients in our hemodialysis center, and the risk factors which affect the maintenance hemodialysis patients hospitalization and death occurred. [methods] we retrospectively analyzed 310 patients who had been treated with MHD for more than 3 months during the period between Aurgust 2010 and December 2012. The occurrence of hospitalization and deaths was recorded in the period. Hospitalization and/or deaths were defined as an adverse event。Age, sex, duration of hemodialysis, body mass index(BMI), blood pressure, kt/v, c reaction protion(CRP), total cholesterol(CHO), triglyceride(TG), high density lipoprotein(HDL), low density lipoprotein(LDL), serum albumin(ALB), hemoglobin(HGB), calcium(Ca), phosphorus(P), parathyroid hormone(PTH), and calcification score were compared between group with endpoint events and group with no endpoint events. Correlation analysis was made for risk factors relating to the endpoint event. [results] 1)At the end of the observation period, there were 146 cases times of hospitalization，annual rate of hospitalization is 1059 hospitalizations per 1000 patients. The top three causes of hospitalization were infection(45.8%), cardiovascular and cerebrovascular complications(22.6%), vascular access(8.9%). 2) 30 patients was died. The rate of death was 69 per 1000 patients year. The first reason of death was cardiovascular and cerebrovascular complications(56.6%), the next reason of death was infection(23.3%). 3) 208 patients were involved in the analysis about the risk factors finally. Older mean age, higher calcification score , lower serum albumin , and lower hemoglobin were founded in group with endpoint events than group with no endpoint events. Logistic regression analysis showed that lower serum albumin, older age and lower hemoglobin were the risk factors of hospitalization and death. [conclusions] cardiovascular and cerebrovascular disease, infection are the common causes leading to hospitalization and death in MHD patients. older age, lower serum albumin and lower hemoglobin were the independent risk factors of hospitalization and death.

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