老年维持性血液透析患者短期死亡因素分析

摘要

Objective To analyze the causes of early death in elderly patients undergoing maintenance hemodialysis ( MHD) and major risk factors.Methods A retrospective study was conducted.Fourty-three patients who had undergone MHD between January 2005 and December 2015 and died within 3 -12 months after hemodialysis in the Hemodialysis Center of China Aerospace Center Hospital were included in Group A while 106 patients who had undergone hemodialysis in the same period but survived for over 12 months were selected as control group(Group B).Results The main causes of early death of 43 elderly patients with MHD were cardiovascular ( 46.5%) and cerebrovascular diseases ( 25.6%) (CCVD), and infections(14.0%).The age,proportion of patients with diabetes and CVD,and the proportion of patients using the central venous catheter( CVC) as vascular access were higher in Group A,but the level of hemoglobin and serum albumin was lower.Indicators of cardiac structure and function showed that the left ventricular end-diastolic diameter (LVDd),left ventricular posterior wall thickness(LVPWT),and left ventricular myocardial quality index(LVMI)in Group A were well above those in Group B, but EF and E/A ratio were significantly lower(P<0.05 and P<0.01).COX regression analysis indicated that the comorbidity with CVD, a lower level of serum albumin and EF were the main risk factors for early mortality in elderly patients under MHD.Conclusion The main cause of early death in elderly MHD patients is CCVD.The comorbidity of CVD, malnutrition and decreased left ventricular systolic function might be the main risk factors for early mortality in elderly MHD patients.Early and adequate dialysis,active treatment of underlying diseases, and the correction of hypoalbuminemia can decrease complications,prolong life and improve the quality of life.%目的：探讨老年维持性血液透析（ MHD）患者短期死亡（血液透析后3～12个月内死亡）的原因及影响因素。方法2005年1月～2015年12月在航天中心医院开始MHD并于3～12个月内死亡的43例老年患者为A组，同期开始MHD且生存时间＞12个月的106例老年患者作为对照组（ B组），回顾性地分析导致老年MHD患者短期死亡的主要原因及相关危险因素。结果老年MHD患者短期死亡的主要原因是心血管疾病（46．5％）、脑血管疾病（25．6％）和感染性疾病（14．0％）。两组在血液透析方式、血流量方面差异无统计学意义（P＞0．05）。但A组患者年龄、透析前并存糖尿病及心血管疾病的比例、使用中心静脉导管作为血管通路的患者比例明显高于B组（均P＜0．05），而血红蛋白、血浆白蛋白水平明显低于B组（P＜0．05）。心脏结构和功能的指标显示，A组左心室舒张末内径（ LVDd）、左心室后壁厚度（ LVPWT）及左心室体积指数（ LVMI）均高于B组，左心室射血分数（ EF）及舒张早期和舒张晚期二尖瓣口最大血流速度之比（E／A）低于B组，差异具有统计学意义（P＜0．05或0．01）。 COX回归分析结果显示，透析前并存心血管疾病、低血浆白蛋白、低EF值是老年MHD患者短期死亡的主要危险因素。结论心脑血管疾病是老年MHD患者短期死亡的主要原因，合并基础心脏病、营养不良、左室收缩功能减退是其死亡的主要因素。积极治疗基础病、早期充分透析、加强并发症防治、改善营养状态、注重心脏功能改善能提高老年患者的生活质量、延长生存时间。