终末期肾衰竭腹膜透析患者的转归及其危险因素分析

目的:探讨影响终末期慢性肾衰竭连续性不卧床腹膜透析患者死亡危险因素及其防治对策.方法:对1999年8月～2003年8月期间我院52例慢性肾衰竭腹膜透析患者的资料进行回顾性临床分析.其中死亡组22例、存活组30例,分析其死亡原因和影响因素.结果:(1)52例腹膜透析患者死亡组的22例中,死于心血管病变13例(占59.1%),腹膜炎3例(占13.6%),肺部感染2例(占9.1%),严重营养不良2例(占9.1%),其他2例(占9.1%).(2)死亡组年龄、性别分布与存活组比较无统计学差异(P＞0.05);与存活组比较,死亡组的体重、平均动脉压明显升高,血浆白蛋白明显降低,均有统计学差异(P＜0.05).(3)死亡组的透析龄、透析液总剂量、腹腔超滤量、尿量及液体总清除量与存活组比较均无统计学差异(P＞0.05);然而死亡组的水肿发生率明显高于存活组,分别为68.2%及43.3%(P＜0.05).(4)死亡组透析初始时的尿素氮、肌酐、肌酐清除率、血色素、总胆固醇、甘油三酯与存活组相比无统计学差异(P＞0.05).(5)糖尿病腹膜透析患者的水肿发生率和病死率均明显高于非糖尿病患者(P＜0.05),16例糖尿病患者有11例死亡,非糖尿病患者36例中有11例死亡(病死率分别为68.8%VS 30.6%).结论:心血管疾病是终末期肾衰竭腹膜透析患者最主要的死亡原因.容量超负荷、糖尿病、控制不良的高血压、营养不良以及透析时机过迟都是影响终末期肾衰竭患者心血管病死亡的主要危险因素.积极维持体液平衡、控制血压及糖尿病合并症,并根据患者的残余肾功能、临床症状、合并症情况和营养状态综合考虑,及时开始CAPD治疗,将有助于改善患者的预后.

Analysis of the Risk Factors Associated with Mortality in Peritoneal Dialysis Patients

Objective:To analyze the risk factors that influences the mortality of the ESRD patients receiving continuous ambulatory peritoneal dialysis (CAPD).Methods:We investigate patient's demographic characteristics, clinical data and causes of death. Patients were divided into two groups according to death or survival. Results: A total of 52 patients were included in this study, of which 22 cases died. Among these 22 cases, 13 (59.1 %) cases died from cardiovascular diseases, 3 (13.6%) cases died from peritonitis, 2 (9.1%) cases died from pulmonary infection, 2(9.1%) cases died from severe malnutrition and 2 (9.1%) cases died from others. Compared with survival patients, the mean blood pressure and weights were significantly higher and the initial serum albumin level was significantly lower than survival (P<0.05). There were no significant differences in age, gender, hemoglobin, creatinine clearance rate, dialysate doses, total fluid removed between two groups, whereas the death group had higher fluid overload than survival (P<0.05). Furthermore, there were significantly more edematous patients and had higher mortality in diabetics as compared to non - diabetics (P < 0.05). Conclusion: Our results suggested that cardiovascular disease is the major cause of End Stage Renal Disease patient's death. Maintain fluid balance and control blood pressure are very important. The time to being dialysis should be synthetically determined by residual renal function, nutritional status and complications.