125例维持性血液透析治疗患者退出原因分析

目的探讨维持性血液透析患者退出透析原因及影响生存率和生存质量的相关因素。方法对2002年1月～2007年1月在青岛大学医学院附属青岛市立医院血液净化中心进行维持性血液透析的235例患者进行回顾性分析。结果共125例患者退出治疗,退出率53.19%,其中以死亡、肾移植和因经济原因退出为主,分别占38.40%、21.60%、20.80%。死亡原因以脑血管病为主（31.25%）,其原发病高血压肾病占80.0%;其次为心血管病占25.00%,原发病以糖尿病肾病为主占75.0%。组间比较死亡组平均年龄较大,因全身衰竭和恶性肿瘤死亡者更明显（P〈0.01）。因心血管病、严重感染和全身衰竭死亡者平均透析龄较短（P〈0.05和0.001）。结论维持性血液透析患者退出治疗的主要原因是死亡和经济条件制约,脑血管病是死亡的主要原因,并发症的发生与原发疾病有关,高血压、糖尿病、高龄是影响死亡率的重要因素,老年患者发生全身衰竭和恶性肿瘤的危险性增加,合理选择透析方式和处方能有效延长患者寿命,提高生存质量。

Causes of discontinuing hemodialysis therapy in 125 patients with maintenance hemodialysis

Objective To analyze the causes of discontinuing hemodialysis therapy and the factors relating to their survival rate and living quality in patients with maintenance hemodialyis. Methods We retrospectively analyzed 235 maintenance hemodialysis patients in this hospital during the period from Jan. 2002 through Jan. 2007. Results In these patients, 125 cases （53.19%） discontinued hemodialysis therapy, of which the main causes were death （38.40%）, renal transplantation （21.60%） and economic problems （20.80%）. The main cause of death was cerebrovascular diseases （31.25%）, which were resulted from nephropathic hypertension in 80.0% of these death cases. The next cause of death was cardiovascular diseases （25.0%）, which were the end stage of diabetic nephropathy in 75.0% of these death cases. The death cases had older age, and had deterioration of general condition and malignant tumors in more cases （P〈0.01, as comparison with those of the living cases）. In addition, patients died of cardiovascular diseases, serious infections and deterioration of general condition experienced shorter period of he- modialysis （P〈0.05 and P〈0.001）. Conclusion In patients with maintenance hemodialysis, death and economic problems were the major causes leading to discontinuation of this therapy. Cerebrovascular diseases were the main cause of death. Hypertension, diabetes and older age were the factors relating to the higher mortality rate. Deterioration of general condition and malignant tumor often happened in elder cases. Appropriate dialysis method and dosage will improve their life expectation and living quality.