【摘要】 目的 探讨腹膜透析患者退出原因及死亡原因并分析对策。方法 回顾性分析邯郸市中心医院腹膜透析中心2007年1月至2011年12月的腹膜透析患者资料,统计例数,分析退出原因及死亡原因。结果 共有109例患者退出腹膜透析,退出的主要原因是死亡63例(占57.8%),其次为肾移植5例(占4.6%)、转血液透析9例(占8.3%)、其他32例(占29.4%,因经济原因放弃、转院及失访)。原发病为糖尿病患者的病死率为74.3%(26/35),高血压患者为70.0%(21/30),均显著高于慢性肾炎患者的32.4%(12/37)(P均<0.05),前两者间的差异无统计学意义(P>0.05)。死亡的首位原因是心血管事件23例(占36.5%),其余依次是脑血管事件13例(占20.6%)、感染11例(肺部感染和腹腔感染,占17.5%)、营养不良11例(占17.5%)、呼吸系统疾病3例(占4.8%)、肿瘤2例(占3.2%)。其中透析开始前合并心功能不全的病死率高,存在残余肾功能的透析患者病死率低,两者与肾移植组比较,差异有统计学意义(P均<0.05)。研究期间腹膜透析患者共发生腹膜炎75例,操作不当38例(占50.7%),腹泻25例(占33.3%),重复用帽7例(占9.3%),隧道炎2例(占2.7%),便秘1例(占1.3%),尿路感染1例(占1.3%),使用国产腹膜透析液1例(占1.3%)。结论 死亡是持续性不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者退出腹膜透析的主要原因,患者死亡的主要原因为心脑血管病和感染。高龄、糖尿病、残余肾功能差、血压、营养不良、感染和透析前心功能状况是影响患者生存的危险因素。更多还原

【Abstract】 Objective To investigate the reasons for patients’ withdrawal from peritoneal dialysis(PD),further to analyze the death causes of PD patients,and to search for the counter measures.Methods The clinical data of PD patients at Handan Hospital Dialysis Center from January 2007 to December 2011 were retrospectively analyzed,including the number of cases,the reasons of death and drop-out.Results A total of 109 patients were out of PD,the main reason of withdrawal was death(63 cases,57.8%),followed by kidney transplantation(21 cases,4.6%),conversion to hemodialysis(23 cases,8.3%),the other caused(32 cases,29.4%).The mortality in patients with the primary disease being diabetes was 74.3%(26/35),and 70.0%(21/30) in patients with hypertension,which was significantly higher than in those with chronic nephritis(32.4%,12/37,P<0.05).The leading cause of death was cardiovascular events(36.5%),followed by cerebrovascular events(20.6%),infection(infection of the lungs and abdominal infections,17.5%),respiratory diseases(4.8%),malnutrition(17.5%),and cancer(3.2%).Before the start of dialysis,the dialysis patients who combined with cardiac dysfunction had high mortality,and the patients with residual renal function had low mortality,both of showed statistically significant difference from the control group(the renal transplant group,P<C0.05).Peritonitis occurred in 75 cases during the study period in the PD center.Conclusions Death is the leading cause of PD drop-out,and the main reasons for death in PD patients are cardiocerebrovascular diseases and infections.Age,diabetes,insufficient residual renal function,blood pressure,malnutrition,infection and cardiac functional status before dialysis are the risk factors influencing the survival of PD patients.更多还原