维持性血液透析患者死亡原因的临床分析  

Analysis of the Death Causes in Patients Treated with Maintenance Hemodialysis

作　　者：钱春梅[1] 王秦[1] 李军辉[2] 范瑛[2] 汪年松[2] 盛晓华[2] 

机构地区：[1]上海市第六人民医院南院肾内科,上海201499 [2]上海交通大学附属第六人民医院肾内科,上海210023

出　　处：《中国中西医结合肾病杂志》2015年第2期116-120,共5页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：国家自然基金面上项目(No.81270824);上海市科委基础研究重大项目(No.11DJ1400101);上海市科委重大项目(No.11DZ1973103);上海交通大学医学院科技基金资助项目(No.11xj21058)

摘　　要：目的：探讨维持性血液透析患者主要死亡原因及影响因素。方法：回顾性分析2008年1月~2013年12月上海市第六人民医院及上海市第六人民医院南院行维持性血液透析患者资料,剔除透析龄〈3月患者,共计380例,死亡患者96例,分析患者的死亡原因及影响因素。结果：96例死亡病例中男62例,女34例,主要死亡原因为：心脑血管疾病48例（50%）,感染性疾病18例（18.75%）,肿瘤16例（16.67%）。〈60岁28例,≥60岁68例,其中糖尿病患者居多。高血磷组（〉1.45 mmol/L）患者心血管疾病死亡率明显高于正常血磷组（≤1.45 mmol/L）,差异有统计学意义,提示血磷水平越高,心血管死亡风险越大。Logistic回归分析提示白蛋白、尿素氮、肌酐是MHD患者死亡的危险因素。与非心脑血管疾病死亡患者相比,死于心脑血管疾病的患者其透析龄较短,血清肌酐、血红蛋白、白蛋白、三酰甘油、胆固醇均较高。结论：心脑血管疾病是维持性血液透析患者最主要的死亡原因,其次为感染和肿瘤;糖尿病是影响预后的重要原因,控制血磷水平,有助于减少死亡风险。Objective： To investigate the leading causes of death and related factors in maintenance hemodialysis（ MHD） patients. Methods： We retrospectively analyzed the MHD patients treated in Shanghai Jiaotong University Affiliated Sixth People Hospital and Shanghai Jiaotong University Affiliated Sixth People Hospital South Campus in the period of Jan. 2008 to Dec. 2013. Eliminated the patients treated less than three month. There were 380 patients total,96 patients died. Analysis the causes of death of patients and affected factors. Results： In the 96 death cases,62 cases were males and 34 cases were females. The main causes of mortality were cardiovascular and cerebrovascular diseases（ 48,50%）,infectious diseases（ 18,18. 75%）,malignancies（ 16,16. 67%）. 48 cases were older than 60. Diabetic nephropathy was frequently found in elderly group. Cardiovascular mortality in patients with high blood phosphorus（ 〉1. 45 mmol / L） was significantly higher than normal blood phosphorus（ ≤1. 45 mmol / L）. There was statistical significance. That means higher blood phosphorus accompanied higher risk of death on cardiovascular. Logistic regression analysis showed that albumin,urea nitrogen,serum creatinine maybe the risk fators of MHD patients. Compared with the non- cardiovascular and cerebrovascular diseases,die of cardiovascular and cerebrovascular diseases,it＇s dialysis age was shorter,and serum creatinine,HB,albumin,triglyceride,and cholesterol were higher. Conclusion： In maintenance hemodialysis patients,the main cause of death was cardiovascular and cerebrovascular disease,the second was infection and tumor. Diabetes was the important factor affecting the prognosis. Control blood phosphorus levels maybe reduce the mortality.

关 键 词：维持性血液透析 死亡原因 心脑血管疾病 感染 肿瘤 

分 类 号：R459.5[医药卫生—治疗学]