长期腹膜透析患者转归分析

目的 探讨长期腹膜透析患者的临床转归及临床特点.方法 对海军总医院腹膜透析时间超过1年的67例腹膜透析患者临床资料进行回顾性分析.根据其临床转归分为维持腹膜透析组(37例)、转向血液透析组(4例)、转向移植组(2例)及死亡组(24例).结果 死亡组血清白蛋白水平及总尿素清除指数(Kt/V)明显低于维持腹膜透析组、转向血液透析组、转向移植组[(21±4)g/L比(29±6)、(30±4)、(36 ±7) g/L,(1.52±0.15)比(1.81±0.16)、(1.86±0.35)、(1.95±0.17),均P＜0.05].维持腹膜透析组水清除指标明显高于转向血液透析组、转向移植组及死亡组[日超滤量(UF)+尿量(UV):(1.93±0.33)L比(1.50±0.08)、(1.65 ±0.35)、(1.33±0.47)L,(UF+ UV)/体表面积:(1.14±0.12)比(1.04±0.03)、(1.07±0.09)、(0.87±0.37),均P＜0.05].维持腹膜透析组及转向移植组残肾功能明显高于转向血液透析组、死亡组[残肾Kt/V:(0.43 ±0.21)、(0.39±0.06)比(0.10±0.04)、(0.18±0.09),残肾内生肌酐清除率(Ccr):(13.1±8.8)、(17.8±2.7)L·周-1·(1.73 m2)-1比(2.4±1.1)、(5.0±2.1)L·周-1· (1.73 m2)-1,均P＜0.05].死亡组死亡前3个月总Kt/V及总Ccr均明显低于死亡前1年[分别为(1.52±0.15)比(1.82±0.17),(46 ±7)L·周-1·(1.73m2)-1比(58±6)L·周-1·(1.73m2)-1,P ＜0.05或P＜0.01].死亡组24例中有10例死于心脑血管疾病.结论 心脑血管疾病是死亡的最主要病因.透析不充分、营养不良以及血压控制不佳都是死亡的重要原因.残肾功能可影响预后.

Analysis of outcomes in long-term peritoneal dialysis patients

Objective To analyze the clinical data of long-term peritoneal dialysis （PD） patients; to dis- cuss the clinical outcomes and clinical features. Methods The data of 67 PD patients survived more than 1 year were reviewed. According to the different clinical outcomes, the patients were divided into four groups： continuous PD group, hemodialysis （HD） group, transplant group and death group. Results The recent serum albumin and total Kt/V in death group were significantly lowered than those in other three groups[ （21 ±4）g,/L vs （29 ±6）, （30 ± 4）, （36 ±7）g/L, （1.52 ±0.15）vs （1.81 ±0.16）, （1.86 _±0.35）, （1.95 ±0.17）, all P 〈0.05]. The fluid removal in continuous PD group was significantly higher than that in the other three groups [ urinary filtration（UF） ＋ urinary volume （UV） ： （ 1.93 _± 0.33 ） L vs （ 1.50 ± 0.08）, （ 1 .65 ± 0.35 ）, （ 1.33 _± 0.47 ） L, （ UF ± UV）/body surface area（BSA） ： （1.14 ±0.12） vs （1.04 ±0.03）, （1.07 ±0.09）,（0.87 ±0.37）, all P〈0.05]. The re- sidual renal Kt,/V or residual renal Ccr in continuous PD group and transplant group were significantly higher than those in HD and death groups[ Kt,/V： （0.43 ±0.21）, （0.39 _±0.06）vs （0.10 ±0.04）, （0.18±0.09）, endoge- nous creatinine clearance rate（Ccr） ： （ 13.1 ± 8.8 ）, （ 17.8 ± 2.7） L · week-1 . （ 1.73 m2 ） -1 vs （2.4 ± 1.1 ）, （5.0 ± 2.1 ）L · week-1 . （1.73 m2） _1, all P 〈 0.05 ]. Compared to one year prior to death, the total Kt/V and total Cer of the three months prior to death in death group was significantly lower[ （1.52 ± 0. 15） vs （1.82 ± 0. 17）, （46 ±7）L · week-1 - （1.73 m2） -1 vs （58 ±6）L ^-1 week-1 · （1.73 m2） -1, P〈0.05 orP〈0.01]. Ten out of twenty-four in death group died of cardiovascular diseases and eerebrovaseular diseases. Conclusions Cardi- ovascular and cerebrovascular diseases are the leading causes of death. Dialysis inadequacy, undernutrition and poor blood pressure control are important causes of death. Residual renal function can affect the prognosis.