中老年维持性血液透析患者死亡事件的原因分析

目的分析2005年1月～2011年12月在北京医院维持性血液透析死亡患者的病例特点和死亡原因。方法回顾性的检出维持血液透析大于3个月的死亡患者共83例,计算本中心从2005年起每年维持透析患者的死亡人数和死亡率;将死亡患者根据年龄分为3组,60岁以下中年组,60～79岁老年组和80岁以上高龄组,分析3组的人口学资料、有无糖尿病、透析龄和死亡原因等。结果从2005年起,北京医院每年维持透析患者的死亡率依次为11.00%,10.90%,8.30%。8.10%,10.10%,8.70%和6.34%;83例死亡患者中,男性49例,女性34例,平均年龄71.812.0岁(42岁～94)岁,中年组(小于60岁)14例,老年组(60～79)岁46例,高龄组(大于80)岁23例;3组患者在性别上无统计学差异。透析龄在中年组最长,平均77.2±73.0月,高龄组为44.0±35.5月,老年组透析龄最短,平均为33.2±28.1月;3组之间的差异有统计学意义。老年组患者糖尿病肾病居多;死亡原因在各组有明显的差别,中年组50%死于脑血管疾病,脑出血居多;高龄组56.50%死于感染中毒性休克。老年组死亡原因较复杂,死亡率超过10%的依次为感染中毒性休克、心肌梗死或心力衰竭、肿瘤、营养不良-炎症-动脉粥样硬化综合征(Malnutrition-inflammation-atherosclerosissyndrome,MIAsyndrome)和猝死。结论北京医院单中心血液透析死亡患者绝大多数为老年患者。年龄不是决定透析预后不良的主要危险因素,糖尿病是影响预后的重要因素,不同年龄组患者死亡原因不同,中年患者脑血管疾病多见,高龄患者感染中毒性休克常见,老年患者的死亡原因多样化,包括心脑血管疾病、感染、肿瘤和MIA综合征。±

investigation on death events in end-stage renal disease patients undergoing hemodialysis

Objective To analyze the characteristics of the maintenance hemodialysis(MHD) patients died in this hospital from January 2005 to December 2011,and to investigate the risk factors relating to the death in elderly MHD patients.Methods Retrospective study on MHD patients in the period from January 2005 to December 2011 found 83 death cases that had treated with MHD for more than 3 months.The annual number of death cases and mortality rate were then calculated.These cases were divided into 3 groups:middle age group(<60 years of age),elderly group(60 to 79 years of age),and very elderly group(>80 years of age).Demographic features,diabetes,dialysis age and cause of death were analyzed among the three groups.Results The annual mortality rate in MHD patients from 2005 to 2011 was 11.00%,10.90%,8.30%,8.10%,10.10%,8.70% and 6.34%,respectively.Of the 83 death cases,49 cases were males and 34 cases were females,with the mean age of 71.8?2.0 years(42～94 years).Fourteen cases were in middle age group,46 cases in elderly group,and 23 cases in very elderly group.Sex difference was insignificant among the three groups.Dialysis age was longer in middle age group,and was shorter in elderly group.Diabetic nephropathy was frequently found in elderly group.The causes of death were different.In middle age group,50% cases died of cerebral vascular disease,especially cerebral hemorrhage.In very elderly group,56% cases died of septic shock.In elderly group,death was resulted from various causes,including septic shock,cardiac infarction or heart failure,tumor,malnutrition-inflammation-atherosclerosis syndrome(MIA syndrome) and sudden death(in order of the prevalence rate).Conclusions Most of the death cases in this dialysis center were older than 60 years of age.Diabetes played a role more important than age on the prognosis of MHD patients.Cerebral vascular disease was the major cause of death in middle age patients,and septic shock is the main cause in very elderly patients.The causes leading to death in elderly patients were various,including cardiovascular disease,infection,tumor and MIA syndrome.