倾向匹配前后临时血液透析对维持性腹膜透析病人生存预后的影响

发布时间：2018-03-08 18:35

本文选题：终末期肾病　切入点：腹膜透析　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨倾向匹配前后临时血液透析对维持性腹膜透析患者生存预后的影响及相关因素。方法:回顾性分析2010年1月1日至2014年12月31日植入腹膜透析管并维持腹膜透析患者的临床资料,患者至少规律随访3月。数据来自浙江省透析质量控制中心的透析登记系统。根据腹膜透析前有、无血液透析史分为2组:未血液透析组,临时血液透析组(血液透析时间3月)。采用Kaplan-Meier生存曲线、COX回归分析比较2组生存率及影响生存相关因素。结果:纳入腹膜透析患者共908人,其中未血液透析组为732人,临时血液透析组176人。未血液透析组的1年、2年、3年及4年患者生存率分别为96.2%、91.4%、88%和85%;临时血液透析组为92.8%、88.8%、78.2%和78.2%,差异具有统计学意义(P0.05);两组患者技术生存率无明显差异。COX回归分析提示患者临时血液透析史、年龄、血清白蛋白水平以及合并症指数等级是影响生存的独立危险因素。然而使用倾向性匹配后再次进行2组的预后及生存率比较,未行血透组的1年,2年,3年,4年生存率分别为96%,89%,84%,84%,临时血透组的1年,2年,3年,4年生存率分别为93%,90%,81%,81%,2组的生存率没有显著性差异,P0.05,技术生存率也没有显著性差别,并且发现临时血透并非是影响预后的独立危险因素,而年龄、血清白蛋白、合并症指数、透析时的尿量才是独立危险因素。结论:有临时血液透析史的腹膜透析患者长期生存率明显低于无血液透析史患者,但倾向性匹配后2组的生存率并无显著性差异,其中年龄,血清白蛋白,合并症指数,透析时的尿量是独立危险因素,这些因素极大程度的影响透析预后,选择一个合适的透析方式和透析时机应受到重视,针对不同患者制定个体化的透析方案,同时需重视患者的透析前计划与宣教。
[Abstract]:Objective: to investigate the effect of temporary hemodialysis before and after tendency matching on survival and prognosis of maintenance peritoneal dialysis patients and its related factors. Clinical data of patients with peritoneal dialysis, The patients were followed up regularly at least March. The data were obtained from the dialysis registration system of Zhejiang Dialysis quality Control Center. According to the previous peritoneal dialysis, the patients were divided into two groups without hemodialysis history: the non-hemodialysis group. Kaplan-Meier survival curve and Cox regression analysis were used to compare the survival rate and factors related to survival in the temporary hemodialysis group (hemodialysis time March). Results: 908 patients were included in peritoneal dialysis, including 732 patients in the non-hemodialysis group. There were 176 patients in the temporary hemodialysis group. The survival rates of the patients without hemodialysis were 96.2kW 91.488% and 85%, respectively, while in the temporary hemodialysis group 92.888% 78.2% and 78.2% respectively, the difference was statistically significant (P 0.05), the technical survival rate of the two groups was not obvious. The difference. Cox regression analysis showed that the patient had a history of temporary hemodialysis. Age, serum albumin level and complication index grade were independent risk factors for survival. However, the prognosis and survival rate of the two groups were compared again after the use of tendentiousness matching. The 1-year, 2-year, 3-year and 4-year survival rates of the non-hemodialysis group were 960.898984, respectively, and the 1-year, 2-year, 3-year, 4-year survival rates of the temporary hemodialysis group were 933.90%, respectively. There was no significant difference in the survival rates of the two groups (P 0.05 and technical survival rates). It was also found that temporary hemodialysis was not an independent risk factor for prognosis, but age, serum albumin, complication index, Conclusion: the long-term survival rate of peritoneal dialysis patients with temporary hemodialysis history was significantly lower than that of patients without hemodialysis history. Serum albumin, complication index and urine volume during dialysis are independent risk factors, which greatly influence the prognosis of dialysis. Individualized dialysis programs should be made for different patients, and attention should be paid to patients' predialysis planning and education.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5

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