吉林省单中心腹膜透析患者临床观察及预后相关因素分析

发布时间：2018-04-22 23:38

  本文选题：腹膜透析 + 生存率　； 参考：《吉林大学》2017年硕士论文

【摘要】：目的:研究我院行维持性腹膜透析患者的临床特点、死亡原因、生存率和技术生存率及其影响因素,从而针对各种影响因素采取积极有效措施,提高患者生存率及技术生存率,改善腹膜透析患者的预后。方法:对2012.1.1-2016.1.1在我院行维持性腹膜透析的184例患者临床资料进行回顾性分析,包括一般指标:性别、年龄、原发病、24小时尿量等;实验室指标:首次透析时生化指标,首次透析、透析半年、1年、2年、3年和4年血红蛋白、血清白蛋白、甲状旁腺激素、血清离子(钙、磷);透析相关指标:腹膜平衡试验、腹膜透析相关性腹膜炎、腹膜透析相关性心脑血管病、透析超滤量、腹膜透析患者的转归及死亡原因等。通过对上述指标进行统计和分析,探讨腹膜透析患者临床特点、治疗效果、生存率及技术生存率的影响因素等。结果:1、一般情况:本透析中心184例腹膜透析患者开始透析时平均年龄为53.3±15.3岁,多分布在50-60岁,平均透析龄为15.4±10.3个月,男女比例为1:1.09。原发病依次为:慢性肾小球肾炎、糖尿病肾病、高血压肾损害、肾小管间质损伤等。残余肾功能平均值4.15±2.78ml/min,腹膜转运功能以高平均转运为主(33.7%);腹膜炎发生率28.26%,4月-5月和10月-12月腹膜炎发生比例较高。截至2016年6月30日,184例腹膜透析患者中死亡20例(10.9%);死亡原因分别为:心血管因素17例(85%),脑血管因素2例(10%),感染因素1例(5%)。2、疗效情况:51.83%的患者血红蛋白≥100g/L,64.58%的患者血浆白蛋白≥35g/L。腹膜透析半年、1年、2年、3年、4年分别有71.01%、72.5%、71.10%、87.50%、66.70%患者血钙控制达标,有52.60%、54.40%、52.60%、75.00%、100.00%患者血磷控制达标,有51.20%、49.30%、57.10%、75.00%、33.30%患者PTH控制达标。3、生存分析:1)运用寿命表分析显示腹膜透析1年、2年、4年生存率为:88.70%、84.10%、84.10%,技术生存率为:79.90%、73.50%、64.30%;随着透析时间延长技术生存率呈下降趋势。2)运用Kaplan-Meier单因素生存分析得出:首次透析时年龄、血肌酐、血尿酸影响腹膜透析患者生存率,将其引入多因素COX回归模型中进行分析,结果显示:患者首次透析时年龄、血肌酐水平为腹膜透析患者生存率的独立影响因素。首次透析时年龄、24小时尿量、高转运、血肌酐水平影响腹膜透析患者技术生存率,将其引入多因素COX回归模型中进行分析,结果显示:首次透析时年龄、24小时尿量、高转运为腹膜透析患者技术生存率的独立影响因素。结论:1、本透析中心维持性腹膜透析患者最常见的原发病为慢性肾小球肾炎,其次为糖尿病肾病。2、本透析中心腹膜透析患者主要死亡原因为心血管事件。3、本透析中心年龄、血肌酐水平为腹膜透析患者生存率的独立影响因素,年龄、24小时尿量和高转运为腹膜透析患者技术生存率的独立影响因素。
[Abstract]:Objective: to study the clinical characteristics, causes of death, survival rate, technique survival rate and its influencing factors in patients undergoing maintenance peritoneal dialysis in our hospital, so as to take active and effective measures to improve survival rate and technical survival rate. To improve the prognosis of peritoneal dialysis patients. Methods: the clinical data of 184 patients undergoing maintenance peritoneal dialysis in our hospital from January 1 to January 2011 were retrospectively analyzed, including general indicators: sex, age, 24 hours urine volume of primary disease, laboratory indexes: biochemical index during the first dialysis, first dialysis, and so on. Hemoglobin, serum albumin, parathyroid hormone, serum ion (calcium, phosphorus), dialysation-related indexes: peritoneal balance test, peritoneal dialysis associated peritonitis, hemoglobin, hemoglobin, serum albumin, parathyroid hormone, dialysate related index: peritoneal balance test, peritoneal dialysis associated peritonitis, Peritoneal dialysis related cardio-cerebrovascular diseases, dialysis ultrafiltration, peritoneal dialysis patients outcome and death causes. The clinical characteristics, therapeutic effect, survival rate and technical survival rate of peritoneal dialysis patients were analyzed. Results: in this dialysis center, the average age of 184 peritoneal dialysis patients was 53.3 卤15.3 years old, most of them were distributed in 50-60 years old, the average dialysis age was 15.4 卤10.3 months, the ratio of male and female was 1: 1.09. The primary diseases were: chronic glomerulonephritis, diabetic nephropathy, hypertensive renal damage, renal tubulointerstitial injury and so on. The mean residual renal function was 4.15 卤2.78 ml / min, the peritoneal transport function was mainly high average transport, and the incidence of peritonitis was 28.26, April to May and October to December respectively. As of June 30, 2016, 20 out of 184 peritoneal dialysis patients died (10.9%), the causes of death were cardiovascular factor (17 cases), cerebrovascular factor (2 cases), infection factor (1 case), hemoglobin 鈮，

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