温州地区维持性血液透析患者死因分析

目的：分析2010年1月至2012年12月温州市18家医院维持性血液透析患者的特点和死亡原因。方法：回顾性分析维持性血液透析大于3个月死亡患者269例的，临床资料，按年龄分3组：20～44岁（青年组），45-64岁（中年组）和≥65岁（老年组），分析3组间透析龄、原发病、死亡原因、首次透析时及死亡前1年内实验室检查的差别。结果：透析龄在青年组最长，平均（49．4±60．3）月，老年组透析龄最短，平均（34．1±26．8）月；死亡患者中原发病以糖尿病最多，占39．4％。脑血管疾病为首要死亡原因，3组患者间差异无统计学意义；心血管疾病为第二位死亡原因，在中年组多见：全身衰竭死亡在老年组患者中最多，占23．7％，3组间差异有统计学意义（P=0．01）。进入透析时及死亡前1年内血肌酐、尿素氮和血白蛋白在3组间差异有统计学意义（P〈0．01或P〈0．05），老年组患者低于青年组和中年组患者。结论：温州地区维持性血液透析死亡患者绝大多数为老年患者，原发病以糖尿病最多见，主要死因为脑血管疾病，其次为心血管疾病，全身衰竭死亡在老年组中较多见，且营养状况相对较差。

Analysis of death causes in patients with maintenance hemodialysis in Wenzhou areas

Objective： To analyze the death causes and the characteristics of the maintenance hemodialysis （MHD） patients died in 18 hospitals of Wenzhou areas of China from January 2010 to December 2012. Methods： The causes of death in patients with MHD for more than 3 months were retrospectively analyzed. These patients, were divided into 3 groups abased on age： young group （20 to 44 years old）, middle age group （45 to 64 years old）, elderly group （ ≥65 years old）. Dialysis age, end stage renal disease （ESRD） causes and the biochemistry indexesat the beginning and within one year prior to death were analyzed among the three groups. Results： Of the 269 death cases, 166 cases were male and 103 female, with the mean age of 66.9 ± 13.7 years old （21 to 93 years old）. 20 cases were in young group, 80 in middle age group and 169 in elderly group. Diabetes was major ESRD cause in all cases. Cerebral vascular diseases and cardiovascular diseases were main death causes among three groups, and there was no significant difference among them. Systemic failure was the secondary death cause in elderly group. Serum creatinine （Cr） and blood urea nitrogen （BUN） at the beginning and within one year prior to death in elderly group were lower than that in the other two groups, the serum albumin was the same as sCr and BUN within one year prior to death. Couelusions： Most of the death cases with MHD in this study are older than 65 years of age in Wenzhou area. Diabetes is a major ESRD cause in all cases. Cerebral vascular diseases are the first death causes and cardiovascular diseases are the second among three groups, Systemic failure as death cause in elderly group is more common. Nutritional status in elderly patients is worse than that in young and middle age patients.