维持性血液透析患者再入院临床风险因素的分析  

Analysis of clinical risk factors for readmission in maintenance hemodialysis patients

作　　者：宋琼[1] 吴蓉[2] 李建华[2] SONG Qiong;WU Rong;LI Jian-hua(The First Clinical Medical College of Lanzhou University,Lanzhou 730000,China;Department of Nephropathy,the First Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第一临床医学院,甘肃兰州730000 [2]兰州大学第一医院肾病科,甘肃兰州730000

出　　处：《河北医科大学学报》2018年第2期137-141,共5页Journal of Hebei Medical University

摘　　要：目的分析慢性肾衰竭维持性血液透析患者6个月内再入院的临床风险因素,为临床预防提供依据。方法选取规律血液透析患者83例。根据6个月内是否发生2次及2次以上入院,将患者分为再入院组和未再入院组,对所有患者临床资料进行回顾性分析,探讨维持性血液透析患者再入院的相关临床风险因素。结果 83例维持性透析患者中有42例6个月内再入院,再入院率为50.6%,再入院原因为心血管并发症14例(33.3%)、感染11例(26.2%),消化道症状8例(19.0%),血管通路不畅5例(11.9%),呼吸衰竭2例(4.8%),脑卒中2例(4.8%)。再入院组患者中心静脉长期导管使用率明显高于未再入院组,城乡居民医保占比例高于未再入院组,入院时血红蛋白低于未再入院组,入院时血磷、氨基末端脑钠肽、超敏C反应蛋白高于未再入院组,出院时血红蛋白、白蛋白水平低于未再入院组,差异有统计学意义(P<0.05)。二元Logstic回归分析结果显示,血管通路、氨基末端脑钠肽、超敏C反应蛋白是维持性血液透析患者再入院的危险因素,出院时血红蛋白是维持性血液透析患者再入院的保护因素。结论维持性血液透析患者6个月内再入院率为50.6%,再入院率较高,主要原因包括心血管并发症、感染。再入院的危险因素包括血管通路、氨基末端脑钠肽、超敏C反应蛋白和出院时血红蛋白水平,影响因素较多,临床上应针对危险因素进行综合干预,以降低再入院率,提高患者的生活质量。Objective To analyze the clinical risk factors of readmission within 6-months among patients on maintenance hemodialysis for chronic renal failure so as to provide guidance for clinical prevention.Methods A total of 83 hemodialysis patients were enrolled in the study.The patients were divided into readmission group and non-readmission group according to whether there were two or more hospital admissions within 6-months.The clinical data of all patients were retrospectively analyzed to identify readmission risk factors.Results Among 83 patients,42(50.6%)had a 6-months hospital readmission.The readmission group had 14(33.3%)patients of cardiovascular complications,11(26.2%)patients of infection,8(19.0%)patients of digestive tract symptoms,5(11.9%)patients of poor vascular access,2(4.8%)patients of respiratory failure,2(4.8%)patients of stroke.The utilization rate of central venous catheter in the readmission group was higher than that in the non-readmission group.The proportion of medical insurance between urban and rural residents in the readmission group was higher than that in the non-readmission group.The admission hemoglobin level was lower than that of the non-readmission group,and the levels of admission serum phosphorus,N-terminal pro brain natriuretic peptide,hypersensitivity C reactive protein were higher than those of the non readmission group.The discharge hemoglobin and albumin levels were lower than those of the non readmission group,the difference was statistically significant(P<0.05).The logstic regression analysis indicated that the risk factors for the readmission included vascular access,N-terminal pro brain natriuretic peptide,hypersensitivity C reactive protein,and the protective factors included discharge hemoglobin.Conclusion The readmission rate was 50.6%in 6-months in the maintenance hemodialysis patients,and the major causes of readmission were cardiovascular complications and infection.The risk factors for readmission include vascular access,N-terminal pro brain natriuretic peptide,hypers

关 键 词：肾透析 病人再入院 危险因素 

分 类 号：R459.5[医药卫生—治疗学]