维持性血液透析患者死亡原因及其相关因素分析

目的探讨维持性血液透析（MHD）患者死亡原因及相关因素。方法对2000年1月～2008年1月在青岛大学医院附属市立医院血液净化中心行MHD3个月以上的306例患者进行回顾性分析,其中死亡71例,其他原因退出治疗101例,统计截止期在透析患者134例。对同期进入透析的死亡和在透析患者的年龄、性别、原发病、透析前后血压、透析间期体重增长率、透析前血肌酐（Scr.PHD）以及尿素清除指数（Kt/V）、血红蛋白（HGB）、红细胞压积（Hct）、白蛋白（ALB）、总胆固醇（CHO）、三酰甘油（TG）、钙（Ca）、磷（P）、甲状旁腺激素（PTH）等相关参数进行比较,并进行死亡危险因素的相关分析。结果死亡原因：心血管病25例（35.21%）,脑血管病23例（32.39%）,全身衰竭8例（11.27%）,严重感染8例（11.27%）,恶性肿瘤6例（8.45%）。死亡组平均年龄大（P〈0.01）,HGB、Hct、ALB、Kt/V、Scr.PHD、PTH均低于在透析组（P〈0.001或P〈0.05）,CHO高于在透析组（P〈0.01）。结论心、脑血管病、全身衰竭和严重感染是MHD患者常见的死亡原因,高龄、贫血、低蛋白血症、高胆固醇血症、低Kt／V及透析前血肌酐水平低是MHD患者死亡的重要危险因素。

Analysis of death causes and related factors in pafients with maintenance hemodialysis

Objective To investigate the causes of death and their related factors in maintenance hemodialysis （MHD） patients. Methods We retrospectively analyzed 306 patients who had treated with MHD for more than 3 months during the period between January 2000 and January 2008. At the end of the observation period, 71 of the patients died, 134 remained to be treated with MHD, and 101 went out of the MHD treatment course for various reasons. Age, sex, primary diseases, blood pressure, inter-dialysis weight gain, Kt/V, hemoglobin （HGB）, hematocrit （HCT）, serum creatinine before hemodialysis （Scr.PHD）, and serum albumin （ALB）, total cholesterol （CHO）, triglyceride （TG）, calcium （Ca）, phosphorus （P） and parathyroid hormone （PTH） were compared between the death cases and the survival cases. Correlation analysis was also made for the risk factors relating to death. Results The causes of death were cardiac complications （25 cases, 35.21% ）, cerebrovascular diseases （23 cases, 32.39%）, generalized failure （8 cases, 11.27%）, serious infections （8 cases, 11.27%）, and malignant tumors （6 cases, 8.45%）. Older mean age （P 〈 0.01）, lower values of HGB, HCT, ALB, Kt/V, Scr. PHI） and PTH （P 〈 0.001 or P 〈 0.05） and higher serum CHO （P 〈 0.01） were found in the death cases than in the survival cases. Conclusions Cardiac complications, cerebrovascular diseases, generalized failure and serious infections are the common causes leading to death in HMD patients. The main risk factors relating to death include elder age, anemia, hypoalbuminemia, hypercholesterolemia, insufficient Kt/V and lower Scr. PHD.