尿毒症患者死因及其危险因素  

Death causes and risk factors of uremia patients

作　　者：赖寒[1] 甘华[1] 李革[2] 杨德香[3] 

机构地区：[1]重庆医科大学附属第一医院肾内科,400016 [2]重庆医科大学公共卫生学院流行病学教研室 [3]重庆医科大学公共卫生学院公共卫生学院统计学教研室

出　　处：《中华肾脏病杂志》2011年第11期815-818,共4页Chinese Journal of Nephrology

摘　　要：目的探讨尿毒症患者的死因及其危险因素，从而改善尿毒症患者的预后。方法回顾性分析我院2001年至2011年住院及门诊尿毒症患者247例的临床资料。以死亡患者为死亡组（n=124），存活患者为对照组（n=123）。对死因、原发病因、两组患者的血液透析频率、血清前白蛋白、血清白蛋白、血钠、肺部感染进行对照研究。结果尿毒症患者的死亡与年龄、性别无关。心血管疾病为最常见的死因，以下依次为呼吸衰竭、尿毒症脑病、脑出血、消化道大出血等。死亡患者的血液透析频率、血清前白蛋白及白蛋白、血钠均明显低于对照组，并且更多并发肺部感染（P〈0．01）。Logistic多因素分析显示，透析频率每减少1次／周，死亡风险增加40．7％；血清前白蛋白每降低50mg／L，死亡风险增加53．4％；血钠每降低5mmol／L，死亡风险增加14．6％；并发肺部感染患者死亡风险为未并发肺部感染患者的15．06倍；糖尿病患者死亡风险为非糖尿病患者的4．26倍。结论心血管疾病、呼吸衰竭、尿毒症脑病、脑出血、消化道大出血为尿毒症患者常见死因。血液透析频率、血清前白蛋白、低钠血症、肺部感染、糖尿病为尿毒症患者死亡危险因素。Objective To investigate the death causes and risk factors of uremia patients in order to improve the prognosis of uremia patients. Methods Clinical data of 247 uremia inpatients and outpatients from 2001 to 2011 in our hospital were retrospectively analyzed. Dead patients were served as death group （n=124） and survival patients as control group （n=123）. Death causes and primary disease were studied. Frequency of hemodialysis, prealbumin, albumin, natremia and pulmonary infection were compared between two groups. Results Age and gender were not associated with the death of uremia patients. The most common cause of death was cardiovascular disease followed by respiratory failure,uremic encephalopathy, cerebral hemorrhage, gastrointestinal hemorrhage, etc. Hemodialysis frequency, prealbumin, albumin and natremia of dead patients were obviously lower than those of control group. More patients in death group suffered from pulmonary infection. Logistic multivariate analysis revealed that death risk increased by 40.7% when reducing 1 time per week of hemodialysis; death risk increased by 53.4% when reducing 50 mg/L of prealbumin; death risk increased by 14.6% when reducing 5 mmol/L of blood sodium; death risk of patients with pulmonary infection increased by 15.06 times of patients without pulmonary infection; death risk of diabetes mellitus increased by 4,26 times of patients without diabetes mellitus. Conclusions Cardiovascular disease, respiratory failure, uremic encephalopathy, cerebral hemorrhage, and gastrointestinal hemorrhage are common causes of death in uremia patients. Hemodialysis frequency, prealbumin, hyponatremia, pulmonary infection and diabetes can be regarded as risk factors for death of uremia patients.

关 键 词：尿毒症 死因 危险因素 

分 类 号：R692.5[医药卫生—泌尿科学]