尿毒症维持性血液透析患者死亡原因分析及其对策

[目的 ]　初步分析尿毒症维持性血液透析患者死亡原因 ,并探讨其防治对策。 [方法 ]　对我院血液透析中心 1999年 1月至 12月共 2 44例血透维持 1月以上的尿毒症患者进行有关临床分析。 [结果 ]　 2 44例患者中死亡 12例 ,其中 7例死于脑溢血 ( 5 8.3 % ) ,4例死于心力衰竭 ( 33 .3 % ) ,1例死于严重肺部感染 ( 8.4% )。死亡组患者平均年龄显著大于成活组患者 ,左心室肥厚及贫血程度也较成活组严重 ,动脉收缩压及透析间期体重增长率较成活组高 ,而血清白蛋白 ,血清总胆固醇 ,血清肌酐及尿素氮浓度等反映患者营养状态的指标均较成活组低。死亡组患者平均血透时间较成活组明显缩短。 [结论 ]　心脏及血管并发症是尿毒症维持性血透患者主要的死亡原因。加强患者的健康教育以控制体重的增长 ,重视血透充分性、控制血压、纠正贫血、加强营养支持治疗是预防该类并发症的重要手段。

Clinical analysis on causes of death in patients with uremia on maintenance hemodialysis

Objective To analyze the causes of death in patients with uremia on maintenance hemodialysis and probe into the countermeaasures. [Methods] A total of 244 patients undergoing hemodialysis for at least one month in 1999 were analyzed. [Results] The total number of deaths was 12; cerebral hemorrhage 7 (58.3%), heart failure 4(33.3%),infection 1 (8.4%). The mean age in the deceased group was older than that in the survival group. The systolic blood pressure, the interdialysis weight gain and the left ventricle mass in the deceased group were higher than those in the survival group, but the levels of serum albumin, serum total cholesterol, serum creatinine, and urea nitrogen in the deceased group were much more lower than those in the survival group. The mean duration of hemodialysis in the deceased group was shorter than that in the survival group. [Conclusion] Cardiovascular complications were the leading causes of death in patients with maintenance hemodialysis. Controlling the interdialysis weight gain and blood pressure, improving the anemia and malnutrtion are the significant management of prevention of cardiovascular complications.