摘要
目的 评估高龄肾衰竭患者维持性血液透析（maintenance hemodialysis,MHD）的临床特点.方法 分析82例高龄肾衰竭患者（高龄组）行血液透析治疗前基线情况,包括血压、体质量指数、血红蛋白（haemoglobin,Hb）、尿素氮（BUN）、血肌酐（SCr）、血白蛋白（serum albumin,Alb）;同期进行血液透析治疗的156例非高龄患者设为对照组,定期监测2组患者透析阶段一般治疗情况、透析充分性、血红蛋白（haemoglobin,Hb）、血白蛋白（serum albumin,Alb）、甲状旁腺素、C反应蛋白、心功能测定、营养状况等,透析中合并症和治疗阶段心脑血管并发症的发生情况,统计分析高龄透析患者临床治疗特点.通过生存率和死亡原因分析,总结影响高龄患者透析生存质量的主要因素.结果 高龄组与对照组相比,病因以继发性（高血压、糖尿病）为主、整个透析阶段Alb和SGA低于对照组（P＜0.05）,Kt/V值低于对照组（P＜0.05）、心功能指标左心室舒张末内径、左心室射血分数低于对照组（P＜0.05）,透析中并发症发生率（40.8％）高于对照组（29.3％）,死亡原因1年内主要为脑血管意外及心血管疾病,超过1年的死亡原因主要为脑血管意外、感染、心血管疾病及严重营养不良,比较不同生存时间（3年以内和超过3年）的临床特征,影响高龄患者生存率的主要因素是糖尿病、低血压、透析前SCr水平高,Kt/V值不达标,贫血,营养不良.增加透析频次,联合采用血液透析滤过（hemodiafiltration,HDF）、血液灌流（hemoperfusion,HP）组合治疗有助于延长透析存活时间.结论 高龄MHD患者营养不良较为普遍,并伴随贫血程度重,心功能差,易感染,从而导致了患者并发症、合并症的发生率增加,生存时间减少,通过改善营养、纠正贫血、采取个体化的透析方案,组合治疗,可以减少高龄透析患者的并发症,提高生存率.
Objective To evaluate the clinical characteristics of maintenance hemodialysis （MHD） in elderly patients with chronic renal failure（CRF）.Methods Analysing the general situations of treatments and clinical indicators of maintenance hemodialysis in 82 elderly CRF patients before be ing treated which consisted of blood pressure,body mass index,haemoglobin,urea nitrogen,creatinine,serum Albumin,etc.At the same period,treat 156 hemodialysis patients who are non elderly as a com pared group,monitoring the general situation,dialysis adequacy,hemoglobin（Hb）,serum Albumin （Alb）,parathyroid hormone,C-reactive protein,measured cardiac function and nutrition score of the two group of dialysis patients at dialysis period regularly.The occurrence situation of complications and dialysis treatment phase of cardiovascular complications,making statistic and analyse clinical treatment of elderly patients on dialysis characteristics.Through analysing survival and causes of death,summa rizing the main factors of quality of life of elderly patients on dialysis.Results Compared with elderly patients with hemodialysis dialysis and the general population with dialysis,the causes of disease are mainly secondary （high blood pressure,diabetes）,serum Alb and modified quantitative subjective global assessment （MQSGA） in whole dialysis stage was significantly lower than the general dialysis population （P＜0.05）,dialysis adequacy （Kt/V）is lower than the compared group （P＜0.05）,left ventricular end diastolic cardiac function index diameter and left ventricular ejection fraction are lower than the control group （P＜0.05）,di alysis complications rate is 40.8％ which 29.3％ higher than the compared group,the main causes of death within 1 year are cerebrovascular accidents and cardiovascular disease （68.4％）,In more than 1 year period,the major causes of death are cerebral vascular accident,infection,cardiovascular disease factors and severe malnutrition （85.0％）,comparing clinical characteristics of different survival time （＜3 years and ＞3 years）,the main factors that influence survival rate of patients are diabetes,low blood pressure,high predi alysis serum creatinine,Kt/V of non compliance,anemia and malnutrition.Increasing the frequency of dialy sis,adopt the trestment method that combined HDF and HP treatment can help prolong the survival time of dialysis patients.Conclusions For those elderly patients with dialysis,malnutrition is common and also with severe anemia,poor heart function and vulnerable to injection that result in the increased incidence of compli cations and reduced survival time.By improving nutrition situation,correct ing anemia,taking individual dial ysis progran and joint treatment options,it can reduce the complications of elderly dialysis patients and im prove survival rate.
出处
《临床肾脏病杂志》
2014年第7期393-397,共5页
Journal Of Clinical Nephrology
关键词
高龄
慢性肾衰竭
血液透析
临床
Elderly
Chronic renal failure
Hemodialysis
Clinical
