论文部分内容阅读
目的:分析腹膜透析(PD)患者透析第一年死亡的相关危险因素,并探讨其干预措施。方法:收集南京医科大学第一附属医院PD中心2003年1月至2014年3月248例PD患者的临床资料,分析18例在透析第一年内死亡的患者的危险因素。结果:患者一年内死亡的原因分别为肺部感染7例(38.89%),心血管事件5例(27.78%),全身衰竭1例(5.56%),脑血管事件1例(5.56%),消化道出血1例(5.56%),肿瘤1例(5.56%),感染性休克1例(5.56%),多脏器功能衰竭1例(5.56%)。一年内死亡组与存活组资料比较分析,死亡组年龄高于对照组,且更多合并糖尿病、肺部感染、心血管疾病及使用免疫抑制剂(P<0.01)。将两组患者的辅助检查结果进行对比,死亡组患者估算的肾小球滤过率(e GFR)及C反应蛋白(CRP)高于对照组(P<0.05),血清白蛋白(Alb)(P<0.01)、血清肌酐(P<0.01)及血钾(P<0.05)均低于对照组。结论:高龄、糖尿病、肺部感染、心血管疾病、使用免疫抑制剂、低钾血症均是PD患者在透析第一年死亡的危险因素,低Alb和高CRP是其独立危险因素。积极控制感染、纠正低钾血症、改善营养及微炎症状态有利于改善PD患者的生存。
Objective: To analyze the risk factors related to the first year of dialysis in peritoneal dialysis (PD) patients and to explore the interventions. Methods: The clinical data of 248 PD patients from January 2003 to March 2014 in PD Center of the First Affiliated Hospital of Nanjing Medical University were collected to analyze the risk factors of 18 patients who died in the first year of dialysis. Results: The causes of death in one year were pulmonary infection in 7 cases (38.89%), cardiovascular events in 5 cases (27.78%), systemic failure in 1 case (5.56%), cerebrovascular events in 1 case (5.56% One case (5.56%) of hemorrhage, one case of tumor (5.56%), one case of septic shock (5.56%) and one case of multiple organ failure (5.56%). Mortality group was higher than control group in the death and survival groups within one year. More diabetes, pulmonary infection, cardiovascular disease and immunosuppressive agents were used (P <0.01). Comparisons of the secondary examinations in both groups showed that the estimated glomerular filtration rate (e GFR) and C-reactive protein (CRP) in the death group were significantly higher than those in the control group (P <0.05), serum albumin (Alb) P <0.01), serum creatinine (P <0.01) and serum potassium (P <0.05) were lower than the control group. Conclusion: Age, diabetes mellitus, pulmonary infection, cardiovascular disease, use of immunosuppressive agents and hypokalemia are all risk factors of PD death in the first year of dialysis. Low Alb and high CRP are independent risk factors. Active control of infection, correct hypokalemia, improve nutrition and micro-inflammatory state is conducive to improving the survival of PD patients.