基层医院终末期肾病维持性血液透析患者生存率及死亡原因随访的分析

发布时间：2018-05-13 23:11

本文选题：终末期肾病 + 维持性血液透析　；参考：《山东大学》2014年硕士论文

【摘要】：摘要：目的对基层医院终末期肾病维持性血液透析(MHD)患者进行回顾性随访,探究MHD患者生存率、死亡原因和危险因素,了解基层医院血液透析患者生活质量的相关因素,为基层医院的生存和生活质量的透析患者的进一步改进提供依据。方法将2007年1月至2012年12月在济南市第六人民医院血液净化中心行维持性血液透析的120例终末期肾病患者进行随访分析,对本透析中心120名MHD患者的不同发病原因如慢性肾小球肾炎、糖尿病肾病、高血压肾病等进行回顾性统计分析,并分别计算其所占比例；统计120例MHD患者中维持性血液透析时间在1年以内、1-3年、3-5年的存活例数、死亡例数及其它例数(包括失访例数、转腹膜透析例数等),并计算第1年、3年、5年的患者生存率；统计因心、脑血管意外事件、消化道出血、重症感染以及肿瘤等尿毒症并发症导致死亡的比率；计算不同死亡原因所占总死亡例数的比率；统计在本透析中心行维持性血液透析患者的第1、3、5年相同月份相关实验室检查数据,如尿素氮(Urea)、血清肌酐(Cre)、血清磷(P)、血清钙(Ca)、血红蛋白(Hb)、血糖(Glu)、血清白蛋白(Alb)、总胆固醇(Chol)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL)和低密度脂蛋白(LDL),可能影响患者的生活质量进行统计处理数据。结果(1)在120例MHD患者原发性原因分析发现,慢性肾小球肾炎(50%)是主要原因,其次是糖尿病肾病(35%)和高血压肾病(6.67%)。(2)MHD患者1、3、5年存活组人数分别为115例、91例、62例；1、3、5年生存率分别为95.83%、75.83%、51.67%；本血液净化中心MHD患者的生存率与透析时间呈负相关关系,即随着透析时间延长患者生存率逐年降低。50岁以上MHD患者1、3、5年存活组人数分别为63例、40例、17例,生存率分别为54.78%、43.05%、27.42%；50岁以下MHD患者1、3、5年存活组人数分别为52例、51例、45例,生存率分别为45.22%、56.04%、72.58%。表明50岁以上MHD患者3、5年生存率均低于50岁以下MHD患者。(3)MHD患者1、3、5年各种原发病原因中,糖尿病肾病生存率最低,分别为92.86%、59、52%、35.71%；表明基层医院的MHD患者中糖尿病肾病死亡率最高,应引起重视。(4)55例死亡原因中,以充血性心力衰竭最为多见,有22例(40%)；其次为高钾血症,有16例(29.10%)；脑出血占第三位,有7例(12.73%)；心肌梗塞、消化道出血、重症感染各为3例(5.45%)；肿瘤有1例(1.82%)。表明充血性心力衰竭是MHD患者死亡的首要原因。(5)依据标准偏回归系数大小,对可能引起MHD患者死亡的独立危险因素进行统计分析,发现Hb、Alb为MHD患者死亡的保护因素,高血压、年龄以及血糖为MHD患者死亡的独立危险因素。；(6)将BMI分成为五个区段,并对每个区间段MHD患者的死亡率加以计算。由计算结果可以得知,随着BMI值的增加,患者死亡率逐渐降低,且相关性较好(r2=0.9276)；(7)通过对MHD患者血浆白蛋白水平与死亡率相关性的分析发现,患者血浆白蛋白水平越低,其死亡率越高。结论基层医院血液透析患者慢性肾小球肾炎是最常见的原发性原因。随着维持性血液透析时间的延长,患者的生存率逐年降低,且糖尿病肾病患者在所有随访患者中生存率最低。中青年MHD患者在透析第1.3.5年的生存率均高于老年患者。基层医院MHD患者死亡的首要原因为充血性心力衰竭,且Hb、Alb为MHD患者死亡的保护因素,高血压、年龄以及血糖为MHD患者死亡的独立危险因素。随着BMI和Alb降低MHD患者的死亡率增加。
[Abstract]:Abstract : Objective To investigate the survival rate , cause of death and risk factors of MHD patients in the end - stage renal disease maintenance hemodialysis ( MHD ) patients , and to find out the factors related to the quality of life of hemodialysis patients in basic hospitals .
In 120 MHD patients , the duration of maintenance hemodialysis was within 1 year , 1 - 3 years , 3 - 5 years survival number , number of deaths , and other cases ( including number of missed visits , number of peritoneal dialysis cases , etc . ) , and the survival rate of patients in the first year , 3 years and 5 years was calculated ;
The ratio of death to complications of uremia , such as heart , cerebrovascular accident , gastrointestinal hemorrhage , severe infection , and tumor , is counted ;
Calculate the ratio of the total number of deaths due to different causes of death ;
Results ( 1 ) In 120 MHD patients , we found that chronic glomerulonephritis ( 50 % ) was the main reason , followed by diabetic nephropathy ( 35 % ) and hypertension nephropathy ( 6.67 % ) .
The 1 , 3 and 5 year survival rates were 95.83 % , 75.83 % and 51.67 % , respectively .
The survival rate of MHD patients was negatively correlated with the time of dialysis , that is , the survival rate of patients with MHD was reduced year by year . The survival rates of 1 , 3 and 5 years of MHD patients were 63 , 40 , 17 , 54.78 % , 43.05 % and 27.42 % , respectively .
The survival rates of 1 , 3 and 5 years of MHD patients under 50 years of age were 52 , 51 , and 72 . 58 % , respectively .
The mortality rate of diabetic nephropathy in MHD patients was the highest , which should be paid attention to . ( 4 ) In 55 cases of death , 22 cases ( 40 % ) were most seen with congestive heart failure .
The second was hyperkalaemia , 16 cases ( 29.10 % ) ;
Cerebral hemorrhage accounted for third place , 7 cases ( 12.73 % ) ;
There were 3 cases ( 5.45 % ) of myocardial infarction and digestive tract hemorrhage .
It was found that congestive heart failure was the primary cause of death in MHD patients . ( 5 ) According to the standard partial regression coefficient , the independent risk factors which could cause death of MHD patients were statistically analyzed .
( 6 ) The BMI was divided into five sections , and the mortality rate of MHD patients in each interval was calculated . From the results , it was found that with the increase of BMI , the mortality of the patients was gradually decreased and the correlation was good ( r2 = 0.9276 ) ;
Conclusion Chronic glomerulonephritis is the most common primary cause for patients with MHD . Conclusion Chronic glomerulonephritis is the most common cause for patients with MHD . The mortality rate of MHD patients is higher than that in elderly patients .

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5

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