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目的探讨老年维持性血液透析(MHD)患者短期死亡(血液透析后3~12个月内死亡)的原因及影响因素。方法 2005年1月~2015年12月在航天中心医院开始MHD并于3~12个月内死亡的43例老年患者为A组,同期开始MHD且生存时间>12个月的106例老年患者作为对照组(B组),回顾性地分析导致老年MHD患者短期死亡的主要原因及相关危险因素。结果老年MHD患者短期死亡的主要原因是心血管疾病(46.5%)、脑血管疾病(25.6%)和感染性疾病(14.0%)。两组在血液透析方式、血流量方面差异无统计学意义(P>0.05)。但A组患者年龄、透析前并存糖尿病及心血管疾病的比例、使用中心静脉导管作为血管通路的患者比例明显高于B组(均P<0.05),而血红蛋白、血浆白蛋白水平明显低于B组(P<0.05)。心脏结构和功能的指标显示,A组左心室舒张末内径(LVDd)、左心室后壁厚度(LVPWT)及左心室体积指数(LVMI)均高于B组,左心室射血分数(EF)及舒张早期和舒张晚期二尖瓣口最大血流速度之比(E/A)低于B组,差异具有统计学意义(P<0.05或0.01)。COX回归分析结果显示,透析前并存心血管疾病、低血浆白蛋白、低EF值是老年MHD患者短期死亡的主要危险因素。结论心脑血管疾病是老年MHD患者短期死亡的主要原因,合并基础心脏病、营养不良、左室收缩功能减退是其死亡的主要因素。积极治疗基础病、早期充分透析、加强并发症防治、改善营养状态、注重心脏功能改善能提高老年患者的生活质量、延长生存时间。
Objective To investigate the causes and influential factors of short-term mortality (death within 3 to 12 months after hemodialysis) in elderly patients with maintenance hemodialysis (MHD). Methods From January 2005 to December 2015, 43 elderly patients who started MHD at the Space Center Hospital and died within 3 to 12 months were Group A, 106 elderly patients with MHD over 12 months The control group (group B), retrospectively analyzed the main causes of short-term death in elderly patients with MHD and related risk factors. Results The main causes of short-term death in elderly patients with MHD were cardiovascular disease (46.5%), cerebrovascular disease (25.6%) and infectious disease (14.0%). The two groups in hemodialysis, blood flow differences were not statistically significant (P> 0.05). However, the proportion of patients with age, pre-dialysis co-existence of diabetes and cardiovascular disease in patients with central venous catheter as the vascular access was significantly higher than that in group B (all P <0.05), while hemoglobin and plasma albumin levels were significantly lower than that of B Group (P <0.05). The indexes of cardiac structure and function showed that left ventricular end-diastolic diameter (LVDd), left ventricular posterior wall thickness (LVPWT) and left ventricular volume index (LVMI) in group A were significantly higher than those in group B, left ventricular ejection fraction The ratio of E / A in early diastolic and late diastolic velocities was lower than that in group B, the difference was statistically significant (P <0.05 or 0.01). COX regression analysis showed that pre-dialysis co-existence of cardiovascular disease, low serum albumin, low EF value is the short-term mortality in elderly patients with MHD risk factors. Conclusion Cardiovascular and cerebrovascular diseases are the major causes of short-term mortality in elderly patients with MHD. Combined with underlying heart disease, malnutrition and decreased left ventricular systolic function are the major causes of death. Active treatment of underlying disease, full early dialysis, to strengthen prevention and treatment of complications, improve nutritional status, focus on improving cardiac function can improve the quality of life of elderly patients and prolong survival time.