应用透析登记系统对维持性血液透析患者临终前终止透析治疗的现况调查

目的 回顾性调查维持性血液透析患者临终前是否终止透析治疗及原因,与相应支持治疗情况.方法 应用上海市透析登记系统及原始存档病历收集1998.1.1至2012.12.31期间在上海交通大学医学院附属仁济医院浦西血液透析中心所有死亡血液透析患者.比较提前终止透析与未终止透析患者性别、年龄、透析龄、原发病、死亡原因等情况,并对提前终止血液透析患者的终止原因及支持治疗进行分析.结果 共收集维持性血液透析死亡患者115例,年龄64.6± 14.2岁,中位透析龄5.4（0.3～21）年,其中男性69例,占60％.原发病前3位分别是：慢性肾小球肾炎（27.8％）、高血压肾硬化（23.5％）、糖尿病肾病（12.2％）.死亡原因以脑血管意外（39.1％）、感染（15.7％）、心血管事件（10.4％）、猝死（8.7％）和晚期肿瘤（8.7％）为主.共9例（8％）提前终止透析患者,其中男性7例（77.8％）,女性2例（22.2％）,终止透析后中位存活天数为8.1天.终止透析原因：4例因晚期肿瘤恶液质终止透析,1例为严重感染,1例为脑血管意外,1例为技术原因无法继续给予肾替代治疗,另2例因经济因素患者本人要求终止透析.9例患者均给予相应的支持治疗措施. 结论 透析登记系统是了解临终期血液透析患者终止透析治疗的有效工具.上海交通大学医学院附属仁济医院浦西血液透析中心数据显示8％的临终患者选择了终止透析,远低于发达国家,提前终止透析组以晚期肿瘤为主要死亡原因.

Analysis of dialysis discontinuation and palliative care in maintenance hemodialysis patients by means of dialysis registration system

Objective This retrospective and observational study was carried out to analyze the incidence of dialysis discontinuation and the related palliative care in maintenance hemodialysis （MHD） patients.Methods We retrospectively evaluated the patients who died in Pu-Xi Dialysis Unit of Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai,China from Jan.1,1998 to Dec.31,2012.Their sex,age,dialysis age,and primary disease were compared between dialysis discontinuation group and non-discontinuation group.We also collected the information about cause of death and related palliative care.Results A total of 115 MHD patients （male 69 and female 46; mean age 64.6± 14.2 years old; mean dialysis age 5.4 years） who died in this period were analyzed.The major causes of renal failure were chronic glomerulonephritis （27.8％）,hypertensive nephrosclerosis （23.5％）,and diabetic nephropathy （12.2％）.The most common cause of death was cerebrovascular accident （39.1％）,followed by sepsis （15.7％）,cardiocerebral events （10.4％）,sudden death （8.7％）,and advanced cancers （8.7％）.Of the 9 patients （8％） discounting dialysis,2 were females and 7 were males,and the median living interval after dialysis discontinuation was only 8.1 days.The causes of dialysis continuation included advanced cancers （4 cases）,severe infection （one case）,cerebral accident （one case）,technical difficulties in dialysis （one case）,and financial problems （2 cases）.Support measures were given to all of the 9 patients after dialysis discontinuation.Conclusions Dialysis registration system is useful for the analysis of patients discounting dialysis.In this series of patients,8％ patients discontinued their dialysis,much lower than the ratio in developed countries.The major cause of death in the patients discounting dialysis was advanced cancers.