尿毒症维持性透析患者死亡原因分析及对策

目的分析尿毒症维持性透析患者的死亡原因,探讨其风险因素。方法回顾性分析我院5年来35例维持性透析患者的死亡原因,比较每位死亡患者的透析充分性、血压、贫血程度等方面的情况。结果 35例死亡患者维持性血液透析34例,维持性腹膜透析1例。其中死亡于心血管疾病16例、脑出血11例、感染5例、上消化道出血1例、放弃治疗2例,占总死亡率的百分比分别为45.7%、31.5%、14.2%、2.9%、5.7%。结论心血管疾病、脑血管意外、感染为维持性透析患者最主要的死亡原因。高龄、高血压、低蛋白血症、严重贫血和左心室肥厚是尿毒症维持性透析患者的主要危险因素。积极控制透析患者的高血压、贫血,纠正钙磷代谢紊乱及营养支持治疗,可提高患者生存率及生活质量,达到临床预防目的。

Causes analysis and countermeasures for the death of maintenance dialysis uremia patients

Aim To analyze the causes of death of maintenance dialysis uremia patients and to discuss the risk factors.Methods The death causes of 35 cases of maintenance dialysis uremia patients in recent 5 years were retrospectively analyzed.The influencing factors of dialysis sufficiency,blood pressure,and anemia degree were investigated.Results The 35 death cases comprised 34 cases of maintenance hemodialysis patient,and 1 case of maintenance peritoneal dialysis patients.Among them,there were 16 cases with cardiovascular diseases（45.7%）,11 cases with cerebral hemorrhage（31.5%）,5 cases with infection（14.2%）,1 case with upper gastrointestinal bleeding（2.9%）,and 2 cases abnegated voluntarily（5.7%）.Conclusion Cardiovascular diseases,cerebrovascular accident and infection are the principal causes of death.Old age,hypertension,hypoproteinemia,severe anemia and left ventricular hypertrophy are main risk factors for maintenance dialysis uremia patients.Effective management of hypertension and anemia,correction of Ca and P metabolic disturbance,as well as nutritional support could raise the survival rate and the quality of life.