单中心维持性血液透析患者临床分析

目的：调查深圳市中医院维持性血液透析（maintenance hemodialysis,MHD）患者的现状。方法选择2013年3月至6月在本中心透析的147例 MHD 患者为研究对象,进行横断面调查,统计患者血管通路的种类和人数、每次透析的超滤情况,检测患者血红蛋白、血电解质、甲状旁腺素及透析前、透析后肾功能,并进行统计学分析,评价其透析状况。结果147例 MHD患者中,男女比例为1.58∶1,平均年龄（50.1±14.9）岁,原发病前2位分别为慢性肾小球肾炎和糖尿病肾脏疾病,血管通路以自体动静脉内瘘为主（140例,占95.23%）；本组147例 MHD 患者中,配合采血者122例,采血依从性为82.99%；血红蛋白为（103.03±15.32）g/L,达到贫血治疗目标的患者有33例,达标率为27.04%,半数以上的患者存在轻度贫血；血钾为（5.32±0.79）mmol/L,高血钾症（＆gt;5.3 mmol/L）的患者49例（占40.16%）；血钙为（2.15±0.22）mmol/L（未用血白蛋白校正）,血磷（1.98±0.51）mmol/L,甲状旁腺素为359.2（163.35,825.2）ng/L（四分位分析法）,贫血、血钾和钙磷代谢紊乱控制较差；透析充分性方面,尿素清除指数（Kt/V）值达标率为90.16%；乙型病毒性肝炎患者9例（占6.12%）,无院内新增传染病患者。结论本中心患者大部分透析充分,传染病控制好,但部分患者慢性并发症控制欠佳,有待于加强对患者的管理和治疗。

Current situation analysis of maintenance hemodialysis patients in single hemodialysis center in Shenzhen

Objective To investigate the current situation of maintenance hemodialysis （MHD） patients in Shenzhen Traditional Chinese Medicine Hospital.Methods We choose the MHD patients in our center from March to June 2013 as research objectives.A cross-sectional survey was done to statis-tically count the kind and number of the vascular access,and the ultrafiltration conditions were sur-veyed in each dialysis.Hemoglobin,blood electrolytes,intact parathyroid hormone and renal function before and after dialysis in MHD patients were detected.The results were statistically analyzed,and the current situations of the MHD patients evaluated.Results In 147 MHD patients,the ratio of men to women was 1.58∶1 and the average age was （50.1±14.9）years old.The first primary disease of MHD was chronic glomerulonephritis and the second was diabetic kidney disease.The main vascular access was autogenous arteriovenous fistula （95.23%）.The blood collection compliance was 82.99%. The hemoglobin levels were （103.03±15.32）g/L,while the compliance rate of treatment of anemia was only 27.04%,suggesting that more than half of the patients had mild anemia.The serum potassi-um levels were （5.32±0.79）mmol/L,and there were 40.16% patients who had hyperkalemia.The serum calcium levels were （2.15±0.22）mmol/L （not corrected with serum albumin）and the serum phosphate levels were （1.98 ±0.51）mmol/L.The intact parathyroid hormone levels were 359.2 （163.35-825.2）ng/L.The control for anemia,high potassium,disorders of calcium and phosphorus metabolism was poor.The compliance rate of urea clearance index （Kt/V）was 90.16%.Hepatitis B patients accounted for 6.1%,and there was no new case of infection.Conclusions Most of the MHD patients in our center have adequate dialysis and have no new case of infection.But some chronic com-plications have been poor controlled.We should strengthen the management and treatment for the MHD patients.