【摘要】 目的 :通过对复旦大学附属中山医院近 10年住院期间死亡的尿毒症维持性血透患者的死亡原因进行回顾性分析 ,以期为临床提供一些可防治措施。方法 :选择该院 1990年 1月～ 12月在住院期间死亡的维持性血透患者共 99例 ,将 1999年 1月～ 12月在该院接受 1年以上维持性血透的存活的 2 32例尿毒症患者作为对照进行临床分析。结果 :因心脏原因死亡 4 0例 ,占4 0 .5 % ;脑血管意外 2 9例 ,占 2 9.3% ;感染 15例 ,占 15 .1%。死亡组患者的平均年龄显著高于对照组 (P <0 .0 5 ,平均血透维持时间显著短于对照组 (P <0 .0 0 1) ,血透期间体重的增长率和左心室质量 (LVM)均显著高于对照组 ,而血清白蛋白浓度和红细胞压积则显著低于对照组。因心力衰竭死亡患者其透析期间体重增长率和LVM均显著高于总死亡组。因脑溢血死亡患者的收缩血压显著高于对照组 (P <0 .0 5 )。因感染死亡的患者其血清白蛋白浓度和红细胞压积均显著低于总死亡组。结论 :心力衰竭、脑溢血和肺部感染是本院尿毒症维持性血液透析患者最常见的 3种死亡原因。高龄 (6 5岁以上 )、高血压、低白蛋白血症、严重贫血和左心室肥厚是慢性肾功能衰竭维持性血液透析患者死亡的主要危险因素更多还原

【Abstract】 Objective: The aim of the present study is to analyze the causes of death in maintenance hemodialysis patients. Methods: Between 1990 and 1999 in shanghai zhongshan hospital, a total of 99 end-stage renal disease patients who died after maintenance hemodialysis were included (group A)and there were 232 patients on hemodialysis as control(group B).Two groups patients were studied with matched investigation and correlation analysis. Results: The cardiac complications leading to death accounted for 40.4%. Cerebrovascular events and infection accounted for 39.3% and 15.1% respectively. The mean age in group A was more elder than that in group B (59.6±17.0 vs 54.4±10.4, P<0.05), the interdialysis weight gain and the myocardial mass of the left ventricle (LVM) in group A were more higher than those in group B (4.1±1.3 vs 3.01±0.2%, P<0.05; 305.0±87.9 vs 247.6±41.0g, P<0.05, respectively),but the levels of serum albumin and hematocrit in group A were much more lower than those in group B (33.7±4.2 vs 41.0±0.3 g/L, P<0.01; 21.9±3.7 vs 28.4±3.1%, P<0.01, respectively). The mean duration of hemodialysis was 30.8±5.5 months in those patients who developed congestive heart failure (CHF) in group A, but the interdialysis weight gain and LVM were more higher in group B than those in patients without CHF in group A (5.1±0.6 vs 4.1±1.3%, P<0.05; 332.1±83.6 vs 305.0±87.9g, P<0.05, respectively). The systolic blood pressure in patients with cerebral hemorrhage in group A was more higher than that in group B(23.3±2.9 vs 20.8± 4.5 kPa, P<0.05). The levels of serum albumin and hematocrit in patients with infection in group A were lower than those without infection in the same group (32.1±3.9 vs 33.7±4.2 g/L, P<0.05; 20.6±4.9 vs 21.9±3.7 %, P<0.05, respectively). Conclusion:Cardiac insufficiency was the leading cause of death in patients with maintenance hemodialysis in our centre. The second cause of death was cerebral hemorrhage. The third cause of death was pulmonary infection. The main risk factors of death include elder (over 65 years old), hypertension, hypoalbuminemia, severe anemia, left ventricular hypertrophy.更多还原