单中心维持性血液透析患者透析现状调查分析  

Current status of maintenance hemodialysis patients in single hemodialysis center

作　　者：霍苗苗[1] 余毅[1,2] 林日勇[2] 孙淑清[2] 陈今[2] 王琰[2] 易建伟[2] 

机构地区：[1]福建医科大学福总临床医学院,福建350025 [2]南京军区福州总医院血液净化科,福建350025

出　　处：《临床肾脏病杂志》2012年第11期497-500,共4页Journal Of Clinical Nephrology

摘　　要：目的对单中心维持性血液透析（MHD）患者进行现状调查分析，为透析质量持续改进提供参考依据。方法选择南京军区福州总医院血液净化科412名MHD患者的临床资料进行回顾性分析。结果412例MHD患者中，高磷血症358人（86．99％），钙磷乘积大于55mga／dl。194人（47．15％），iPTH达标率为13．59％。首次透析使用血管通路为临时中心静脉留置导管者345人（83．74％），而以动静脉内瘘作为长期血管通路者395人（95．87％）。412例血红蛋白值为99．35±21．38g／L，其中女性95．50±23．66g／L，男性105．4±11．21g／L，两者均低于正常值（P〈0．05）；其中血红蛋白≥100g／L占46．8％，血红蛋白≥110g／L占26．70；乙型肝炎抗原标志物和丙型肝炎抗体的阳性率分别为14．08％和9．47％；尽管有服用降压药物，本组大于140／90mmHg的高血压患者仍有343人（83．25％），其中使用3种以上降压药物的为315人（76．45％）。全部患者中每周透析三次者仅为214人（51．94％），透析频次与医保种类密切相关，每周透析三次患者的构成比，省医保）市医保）居民医保）自费。结论本中心MHD患者中，仍有部分患者未能很好的控制血磷、PTH水平，贫血、高血压的发生率仍高且达标率低，而医保类型的报销额度一定程度上制约了透析充分性，透析质量有待持续改进。Objective To investigate the current treatment status of maintenance hemodialysis （MHD） patients in our hemodialysis center, so as to provide evidence for continuous improvement of the quality of hemodialysis. Methods Four hundred and twelve MHD patients from our hemodialysis center were analyzed retrospectively in Fuzhou General Hospital of Nanjing Military Command. Re- suits Hyperphosphataemia occurred in 86. 99~, Ca P product higher than 55 mg2/dl2 was 47. 15 and iPTH during 150-300 pg/ml presented 13.59%. In the 412 MHD patients, 83. 47~ of them used provisional catheter as the first vascular access, and 95.87~ of them used AVF as maintenance vascu- lar access. The average level of hemoglobin in male group （1（}5.4 ＋ 11.21g/L） and in the female group （95.50 ＋ 23.66 g/L） was lower than the normal level of hemoglobin （P%0. 05）. The positive percent- age of Hepatitis B antigen markers and anti-HCV was 14. 08~~ and 9. 47~ respectively. Even though antihypertensives were used in 412 MHD patients, BP was unsatisfactorily controlled in 83. 25~ （ BP ~140/90 mmHg）. Three kinds of antihypertensives used accounted for 76. 45~. 6. Dialysis per- formed third a week was found only 51.94~/oo in all patients. In these 51.94~//oo patients, the amount of provincial medical insurance was the most; the others were urban medical insurance, residents~ medi- cal insurance, self-funded patients in turn. Conclusions The control of anemia, hypertension, hyper- phosphataemia and secondary hyperparathyroidism has not reached the goal in MHD patients in our center. And type of medical insurance restricts dialysis adequacy. We still have a long way to go for the goal and need continuous improvement of the quality.

关 键 词：血液透析 现状调查 

分 类 号：R459.5[医药卫生—治疗学]