维持性血液透析患者住院原因及相关因素分析

目的分析血液透析患者住院原因及相关因素。方法对2009年3月～2011年2月首都医科大学附属北京同仁医院99例长期维持性血液透析患者进行回顾性分析,观察住院患者的住院原因,比较住院和非住院患者的年龄、透析龄、收缩压、舒张压、血红蛋白、血糖、透析前血肌酐、透析前血钾、血浆白蛋白、透析前血钙、透析前血磷、全段甲状旁腺激素和透析充分性(Kt/V值)等临床指标,利用多元逐步回归方法分析患者住院的相关危险因素。结果 24个月中,99例患者59人有住院记录;共计住院106例次,平均住院次数为1.07±1.22次;每次住院时间28.27±24.73天;住院的主要原因分别是心血管疾病、血管通路阻塞和肺部感染。住院组患者的年龄显著高于非住院组(66.6±12.62比56.63±13.16,P=0.000)岁,住院组透析前血肌酐和血浆白蛋白显著低于非住院组(804.05±226.01比954.80±226.35,P=0.030)μmol/L和(33.13±4.16比37.30±3.33,P=0.000)g/L。多元逐步回归分析结果发现,低透析龄和低蛋白血症是影响血液透析患者住院的相关危险因素(β=-0.030和-0.413)。结论心血管系统疾病仍然是血液透析患者住院首要原因,血管通路阻塞和肺部感染是血液透析患者住院的重要原因。低蛋白血症和低透析龄是影响其住院的相关危险因素。

Analyses of the cause of hospitalization and its related risk factors in maintenance hemodialysis patients

Objective To analysis the cause of hospitalization and its related risk factor in maintenance hemodialysis （MHD） patients. Method A total of 99 MHD patients were enrolled in this study. Age, dialysis age, blood pressure, hemoglobin, blood glucose, serum creatinine, serum potassium, serum calcium, serum phosphorus, plasma albumin, iPTH and KT/V were compared between hospitalization and outpatient groups. The main causes and its related risk factors for hospitalization were reviewed. Result In the observation period for 24 months, 59 out of the 99 patients were hospitalized with a total hospitalization of 106 times, average hospitalization of 1.07 ± 1.22 times/patient and 28.27 ± 24.73 days/patient. The main causes of hospitalization were cardiovascular disease, stenosis of vascular access and pulmonary infection. Patients were older in hospitalization group than in outpatient group （66.6 ± 12.62 vs. 56.63 ± 13.16 years; P=0.00）. Serum creatinine and plasma albumin before dialysis were lower in hospitalization group than in outpatient group （For serum creatinine： 804.05 ± 226.01 vs. 954.80 4± 226.35 Ixmol/L, P=0.03; for plasma albumin： 33.13 ±- 4.16 vs. 37.30 ± 3.33 g/L, P=0.000）. Stepwise multivariate regression analysis showed that hypoalbuminemia and shorter dialysis age were the risk factors for hospitalization in MHD patients. Conclusion The important causes for hospitalization were cardiovascular disease, stenosis of vascular access and pulmonary infection, in which cardiovascular disease was the leading cause for hospitalization in MHD patients.