腹膜透析患者急性合并症调查及护理对策  

Survey of the acute comorbidities and nursing strategies in peritoneal dialysis patients

作　　者：许莹[1] 杨彬[1] 苏琦[1] 全蕾[1] 董捷[1] 

机构地区：[1]北京大学第一医院肾内科,北京大学肾脏疾病研究所,卫生部肾脏疾病重点实验室,慢性肾脏病防治教育部重点实验室(北京大学)

出　　处：《中国血液净化》2015年第2期120-124,共5页Chinese Journal of Blood Purification

摘　　要：目的本研究旨在调查腹膜透析患者发生的各种急性合并症发生率和住院情况,并分析发生合并症患者的临床特点,为临床实践降低合并症发生率的护理措施提供依据。方法记录2012年度长期随访的腹膜透析患者各类急性合并症发生及住院情况,记录患者发生合并症前1个月的生化指标。将合并症分为感染合并症,心脑血管合并症,非感染导管相关合并症和其他合并症4类。比较各类合并症发生率和住院情况,并比较发生感染合并症和心脑血管合并症患者的临床特点。结果 454例随访患者中发生了急性合并症246例次,涉及182例患者。患者的平均年龄58.25±13.64岁,中位透析龄39.38（20.68~58.06）月,糖尿病患者占47.30%。4类急性合并症发生率依次为感染合并症146例次（59.3%）,心脑血管合并症72例次（29.3%）,非感染导管相关5例次（2.0%）,以及其他合并症23例次（9.3%）。所有急性合并症的转归情况是维持腹膜透析186例次,占75.61%,转血液透析16例次,占6.50%,死亡46例,占17.89%。共有46例次患者住院,住院率为18.70%。平均住院日为8.50（6.00~15.00）。平均单次住院总费用达到13558.59（8809.95~26020.52）元,自付费用699.53（404.51~1772.76）元。心脑血管合并症患者较感染合并症患者血磷水平更高（1.76±0.54 mmol/L vs.1.52±0.44 mmol/L,P=0.020）。结论腹膜透析患者急性合并症及住院率较高,医疗花费高,预后不良。感染作为首要合并症应给予持续关注,而高血磷水平对心脑血管合并症的影响值得重视。Objective We aimed to investigate the incidence of acute comorbidities and hospitalization in peritoneal dialysis patients, and to analyze the clinical charae teristics of the patients with comorbidities for the improvement of nursing strategies. Methods All acute comorbidities and hospitalization in long-term fol- lowed up PD patients in 2012 were recorded. Biochemical data within 1 month prior to the presence of acute comorbidities were collected. Comorbidities were divided into four groups, infection comorbidities, cardiovas- cular or cerebrovascular comorbidities, catheter-related non-infection comorbidities, and other comorbidities. The percentage of comorbidities and hospitalization in the four groups, and the clinical characteristics of infec- tion comorbidities and cardiovascular or cerebrovascular comorbidities were compared. Results A total of 246 episodes of acute comorbidities occurred in 182 PD patients, with the mean age of 58.254-13.64 years, the median dialysis duration of 39.38 （20.68~58.06） months, and diabetes rate of 47.3% patients. The highest percentage of acute comorbidity was infection （59.3%）, followed by cardiovascular or cerebrovascular comor- bidities （29.3%）, catheter-related infection （2.0%）, and other comorbidities （9.3%）. The outcomes of these pa- tients included remaining in peritoneal dialysis （75.61%）, transferred to hemodialysis （6.50%）, and dead （17.89%）. The hospitalization rate was 18.70% with the mean duration of 8.50（6.00--15.00） days and mean medical expenses of 13558.59（8809.95~26020.52） yuan, in which 699.53（404.51~ 1772.76）yuan were paid by patients themselves. Patients with cardiovascular or cerebrovascular comorbidities had higher blood phos-phorus level than those with infection comorbidities （1.76± 0.54 mmol/L vs. 1.52± 0.44 mmol/L, P=0.020）. Conclusions PD patients are prone to have acute comorbidities with higher hospitalization rate, high medical expenses and poor outcome. Infections as the primary comorbidities

关 键 词：腹膜透析 合并症 护理 

分 类 号：R473[医药卫生—护理学]