初始腹膜透析转血液透析患者长期预后的分析

发布时间：2018-04-28 07:22

本文选题：腹膜透析 + 血液透析　；参考：《上海医学》2017年01期

【摘要】：目的了解初始腹膜透析患者转血液透析的原因,观察其长期预后,并分析其死亡原因。方法选取1990年1月1日—2010年12月31日期间在上海交通大学医学院附属仁济医院行维持性血液透析的患者,排除在开始血液透析前有肾移植史和≥2次透析模式转变的患者,最终479例患者纳入研究,其中行单纯血液透析412例(单纯血透组),初始行腹膜透析后转血液透析67例(腹透转血透组)。分析腹透转血透组患者转血液透析的原因;比较两组患者开始透析的年龄、透析龄、性别构成、原发病构成,透析开始后1、5、10年的存活率,以及死亡原因构成。结果腹透转血透组患者转血液透析的原因依次为腹膜炎46例(68.7%),胸膜漏10例(14.9%),超滤衰竭8例(11.9%),其他3例(4.5%)。腹透转血透组患者开始透析的年龄显著小于单纯血透组(P0.05),女性患者比例显著高于单纯血透组(P0.01),透析龄显著长于单纯血透组(P0.05);两组间原发病构成和透析开始后1、5、10年的存活率的差异均无统计学意义(P值均0.05)。在随访期间,腹透转血透组患者死亡31例,死亡原因依次为脑卒中8例(25.8%)、恶液质7例(22.6%)、感染6例(19.4%)、猝死4例(12.9%)、其他3例(9.7%)、心血管事件2例(6.5%)、原因不明1例(3.2%);单纯血透组患者死亡177例,死亡原因分别为脑卒中57例(32.2%)、感染34例(19.2%)、恶液质31例(17.5%)、猝死21例(11.9%)、心血管事件17例(9.6%)、原因不明9例(5.1%)、其他8例(4.5%)。两组间死亡原因构成的差异均无统计学意义(P值均0.05)。结论初始腹膜透析患者转血液透析的主要原因为腹膜炎、胸膜漏和超滤衰竭,其长期预后并不劣于单纯血液透析患者,但该结论有待进一步大样本研究予以证实。
[Abstract]:Objective to investigate the causes of conversion to hemodialysis in patients with initial peritoneal dialysis, to observe their long-term prognosis and to analyze the causes of death. Methods patients who underwent maintenance hemodialysis from January 1, 1990 to December 31, 2010 in Renji Hospital, affiliated to Shanghai Jiaotong University Medical College, were excluded from patients who had a history of kidney transplantation before hemodialysis and who had changed more than two dialysis modes. Finally, 479 patients were included in the study. 412 patients were treated with hemodialysis alone (hemodialysis group), 67 patients were converted to hemodialysis after initial peritoneal dialysis (hemodialysis group). The causes of hemodialysis were analyzed, and the age, age, sex, primary disease, survival rate of 1 ~ 5 and 10 years after hemodialysis were compared between the two groups. Results in the group of hemodialysis, 46 cases of peritonitis (68.7%), 10 cases of pleural leakage (14. 9%), 8 cases of ultrafiltration failure (8 cases) and 4 cases (4. 5%) were involved in hemodialysis. The age of hemodialysis in the dialysis group was significantly lower than that in the simple hemodialysis group, and the proportion of female patients was significantly higher than that in the pure hemodialysis group, and the dialysis age was significantly longer than that in the simple hemodialysis group. There was no significant difference in survival rate (P = 0.05). During the follow-up period, 31 patients died in the hemodialysis group. The causes of death were as follows: 8 cases of stroke, 25. 8%, 7 cases of cachexia, 6 cases of infection, 19. 4%, 4 cases of sudden death, 12. 9%, 9. 7%, 2 cases of cardiovascular events, 2 cases of cardiovascular events, 1 case of unknown reason, 177 cases of death in simple hemodialysis group. The causes of death were 57 cases of stroke, 32. 2% of cerebral apoplexy, 34 cases of infection, 31 cases of cachexia, 21 cases of sudden death, 17 cases of cardiovascular events, 9 cases of sepsis, 9 cases of unknown reason, and 8 cases of other 8 cases. There was no significant difference in the cause of death between the two groups (P = 0.05). Conclusion the main causes of hemodialysis in patients with initial peritoneal dialysis are peritonitis, pleural leakage and ultrafiltration failure, and the long-term prognosis is not inferior to that of simple hemodialysis patients, but this conclusion needs to be confirmed by further large sample studies.
【作者单位】：上海交通大学医学院附属仁济医院肾脏科;
【基金】：上海市卫生和计划生育委员会中西医结合重点项目(ZHYY-ZXYJHZX-1-02) 2015年度公益性行业科研专项(201502023)资助
【分类号】：R692

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