中国血液净化

›› 2003, Vol. 2 ›› Issue (8): 416-418.

• 论著 • 上一篇    下一篇

持续非卧床腹膜透析短期内退出的调查分析

甘红兵 陈孟华 田信奎 汪 涛   

  1. 100034 北京大学第一医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2003-08-19 发布日期:2003-08-19

  • Received:1900-01-01 Revised:1900-01-01 Online:2003-08-19 Published:2003-08-19

RichHTML

0

PDF

167

摘要： 目的 通过分析影响持续非卧床腹膜透析（CAPD）患者一年内退出腹膜透析的因素，以期为 此类易感人群制定合理的一体化治疗方案。方法 调查2000年4月1日至2003年3月31日在本腹透中心进行CAPD的终末期肾病患者的临床资料，包括性别、年龄、透析龄和糖尿病发病情况、退出腹膜透析的时间和原因、死亡病例的死因；采用体格损害指数、Charlson指数来评估患者合并症情况。结果 有139例入选本研究，观察期间退出腹膜透析的有50例(35.97%)，透析后一年内退出的有40例(占总退出例数80%)，其中死亡32例(23.02%)、肾移植4例、转血液透析4例；在三月内退出腹膜透析的有22例，其中死亡20例；在透析后一年内32例死亡病例中，其中死于心肌梗死6例（19%）、充血性心力衰竭7例（23%）、中风3例（9%）、感染5例（16%）、放弃治疗3例（9%）、多器官功能衰竭1例(3%）、呼吸衰竭2例（6%）、恶性肿瘤2例（6%）及其他不明原因3例（9%）；logistic回归分析提示Charlson指数、体格损伤指数、性别对CAPD患者一年内死亡退出的影响的相对危险度分别为1.554、2.125、2.821，并均具有统计学意义（P<0.05）。结论 心血管事件是CAPD患者在透析后一年内死亡的主要原因，合并症是腹膜透析患者一年内退出的重要危险因素。 

关键词: 持续非卧床腹膜透析, 短期退出, 死亡, 合并症, 心血管事件

Abstract: objective To analyze the reason and risk factors associated with dropout of patients within one year after initiation of continuous ambulatory peritoneal dialysis (CAPD). Methods Between 1st April 2000 and 31st March 2003, all new CAPD patients were recruited. Patient demographic characteristics, duration of dialysis, the prevalence of diabetes, date and cause of dropout, cause of death were recorded. Comorbidity at initiation of dialysis was assessed by Charlson index and physical injury index. Results A total of 139 patients were included in this study, of which 50 (35.97%) cases dropped out. Among the 40 cases who dropped out within one year after initiation of CAPD, 32cases died (6died of acute myocardial infarction, 7died of congestive heart failure, 3died of stroke, 5 died of infection, 3died of rejecting treatment, 1 died of multiple system organ failure, 2 died of malignancy, 2 died of respiration failure, 3 died of others), 4 cases received renal transplantation, 4 cases were switched to hemodialysis. The relative risk (RR) of death established by logistic regression analysis for effect of comorbidity assessed by Charlson index and physical injury index, gender on patients dropping out within one year after initiation of CAPD were as follows: Charlson index, RR = 1.554 ( P = 0.004); physical injury index, RR = 2.125 (P = 0.037); gender, RR=2.821 (P=0.034). Conclusions Our study suggests that cardiovascular event is the primary cause of death in patients who dropped out within one year after initiation of CAPD, and comorbidity is an important risk factor for the dropout.

Key words: Early dropout, Death, Comorbidity, Cardiovascular event