维持性血液透析患者死亡原因分析

目的 总结维持性血液透析患者死亡原因,分析其相关影响因素.方法 回顾性分析36例维持性血液透析患者死亡原因及其相关影响因素.结果 36例死亡的血液透析患者中,主要死亡病因为心血管事件15例(41.7％),脑血管意外7例(19.4％),感染7例(19.4％),上消化道出血3例(8.3％),恶性肿瘤2例(5.6％),原因不明2例(5.6％).与非心脑血管疾病死亡患者相比,死于心脑血管疾病的患者中合并糖尿病45.5％(10/22) vs 7.1％(1/14)(P＜0.05)、充血性心力衰竭54.6％(12/22) vs 14.3％(2/14)(P＜0.05)、左心室肥厚50.0％(11/22) vs14.3％(2/14)(P＜0.05)的比例较高,而血白蛋白的水平较低(31.9 g/L vs 36.3 g/L,P＜0.05).进一步进行logistic回归分析提示糖尿病、透析前充血性心力衰竭史、左心室肥厚可能是维持性血液透析患者死亡的危险因素.结论 持性血液透析患者的死亡原因主要为心血管疾病、脑血管疾病和感染.积极改善患者的营养状况,有效预防和干预糖尿病、充血性心力衰竭、左心室肥厚等并发症,可能有助于提高患者的早期和长期生存率.

Death causes and influencing factors in patients with maintenance hemodialysis

Objective To summarize the death causes of patients with maintenance hemodialysis and to elucidate the potential contributing factors. Methods The death causes of 36 patients with maintenance hemodialysis were retrospectively analyzed. Results Among 36 hemodialysis patients, 15 cases died of cardiovascular diseases （15/36, 41.7 M ）, 7 cases died of cerebrovascular accident （7/36,19.4 % ）, 7 cases died of infection （7/36,19.4 % ）, 3 cases died of upper gastrointestinal bleeding （3/36,8.3%）, 2 cases died of cancer （2/36,5.6%） and 2 cases died of unknown aetiology. Patients died of cardiovascular diseases also complicated with diabetes （10/22,45.5%）, congestive cardiac failure （12/22,54.6% ） and left ventricular hypertrophy （ 11/22,50.0% ）, significantly higher than the complicactions in patients died of non-cardiovascular diseases 7.1% （1/14）, 14.3 % （ 2/14 ） and 14.3 % （ 2/14 ）, respectively （ P 〈 0.05）. However, the blood albumin in patients died of cardiovascular diseases was remarkably lower than that in patients died of non-cardiovascular diseases （31.9 g/L vs 36.3 g/L, P 〈0.05）. Logistic regression analysis showed that diabetic history,congestive cardiac failure before hemodialysis and left ventricular hypertrophy might be the risk factors of the death of patients with maintenance hemodialysis. Conclusion Cardiovascular diseases, cerebrovascular diseases and infection are the main causes of death in hemodialysis patients. Therefore, the improvement of nutritional status of patients can prevent and intervene the complications such as diabetes, congestive cardiac failure and left ventricular hypertrophy,so as to improve the early- and long-term survivals of hemodialysis.