本文選題：腹膜透析 + 生存率��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:研究我院行維持性腹膜透析患者的臨床特點(diǎn)、死亡原因、生存率和技術(shù)生存率及其影響因素,從而針對(duì)各種影響因素采取積極有效措施,提高患者生存率及技術(shù)生存率,改善腹膜透析患者的預(yù)后。方法:對(duì)2012.1.1-2016.1.1在我院行維持性腹膜透析的184例患者臨床資料進(jìn)行回顧性分析,包括一般指標(biāo):性別、年齡、原發(fā)病、24小時(shí)尿量等;實(shí)驗(yàn)室指標(biāo):首次透析時(shí)生化指標(biāo),首次透析、透析半年、1年、2年、3年和4年血紅蛋白、血清白蛋白、甲狀旁腺激素、血清離子(鈣、磷);透析相關(guān)指標(biāo):腹膜平衡試驗(yàn)、腹膜透析相關(guān)性腹膜炎、腹膜透析相關(guān)性心腦血管病、透析超濾量、腹膜透析患者的轉(zhuǎn)歸及死亡原因等。通過對(duì)上述指標(biāo)進(jìn)行統(tǒng)計(jì)和分析,探討腹膜透析患者臨床特點(diǎn)、治療效果、生存率及技術(shù)生存率的影響因素等。結(jié)果:1、一般情況:本透析中心184例腹膜透析患者開始透析時(shí)平均年齡為53.3±15.3歲,多分布在50-60歲,平均透析齡為15.4±10.3個(gè)月,男女比例為1:1.09。原發(fā)病依次為:慢性腎小球腎炎、糖尿病腎病、高血壓腎損害、腎小管間質(zhì)損傷等。殘余腎功能平均值4.15±2.78ml/min,腹膜轉(zhuǎn)運(yùn)功能以高平均轉(zhuǎn)運(yùn)為主(33.7%);腹膜炎發(fā)生率28.26%,4月-5月和10月-12月腹膜炎發(fā)生比例較高。截至2016年6月30日,184例腹膜透析患者中死亡20例(10.9%);死亡原因分別為:心血管因素17例(85%),腦血管因素2例(10%),感染因素1例(5%)。2、療效情況:51.83%的患者血紅蛋白≥100g/L,64.58%的患者血漿白蛋白≥35g/L。腹膜透析半年、1年、2年、3年、4年分別有71.01%、72.5%、71.10%、87.50%、66.70%患者血鈣控制達(dá)標(biāo),有52.60%、54.40%、52.60%、75.00%、100.00%患者血磷控制達(dá)標(biāo),有51.20%、49.30%、57.10%、75.00%、33.30%患者PTH控制達(dá)標(biāo)。3、生存分析:1)運(yùn)用壽命表分析顯示腹膜透析1年、2年、4年生存率為:88.70%、84.10%、84.10%,技術(shù)生存率為:79.90%、73.50%、64.30%;隨著透析時(shí)間延長(zhǎng)技術(shù)生存率呈下降趨勢(shì)。2)運(yùn)用Kaplan-Meier單因素生存分析得出:首次透析時(shí)年齡、血肌酐、血尿酸影響腹膜透析患者生存率,將其引入多因素COX回歸模型中進(jìn)行分析,結(jié)果顯示:患者首次透析時(shí)年齡、血肌酐水平為腹膜透析患者生存率的獨(dú)立影響因素。首次透析時(shí)年齡、24小時(shí)尿量、高轉(zhuǎn)運(yùn)、血肌酐水平影響腹膜透析患者技術(shù)生存率,將其引入多因素COX回歸模型中進(jìn)行分析,結(jié)果顯示:首次透析時(shí)年齡、24小時(shí)尿量、高轉(zhuǎn)運(yùn)為腹膜透析患者技術(shù)生存率的獨(dú)立影響因素。結(jié)論:1、本透析中心維持性腹膜透析患者最常見的原發(fā)病為慢性腎小球腎炎,其次為糖尿病腎病。2、本透析中心腹膜透析患者主要死亡原因?yàn)樾难苁录?、本透析中心年齡、血肌酐水平為腹膜透析患者生存率的獨(dú)立影響因素,年齡、24小時(shí)尿量和高轉(zhuǎn)運(yùn)為腹膜透析患者技術(shù)生存率的獨(dú)立影響因素。
[Abstract]:Objective: to study the clinical characteristics, causes of death, survival rate, technique survival rate and its influencing factors in patients undergoing maintenance peritoneal dialysis in our hospital, so as to take active and effective measures to improve survival rate and technical survival rate. To improve the prognosis of peritoneal dialysis patients. Methods: the clinical data of 184 patients undergoing maintenance peritoneal dialysis in our hospital from January 1 to January 2011 were retrospectively analyzed, including general indicators: sex, age, 24 hours urine volume of primary disease, laboratory indexes: biochemical index during the first dialysis, first dialysis, and so on. Hemoglobin, serum albumin, parathyroid hormone, serum ion (calcium, phosphorus), dialysation-related indexes: peritoneal balance test, peritoneal dialysis associated peritonitis, hemoglobin, hemoglobin, serum albumin, parathyroid hormone, dialysate related index: peritoneal balance test, peritoneal dialysis associated peritonitis, Peritoneal dialysis related cardio-cerebrovascular diseases, dialysis ultrafiltration, peritoneal dialysis patients outcome and death causes. The clinical characteristics, therapeutic effect, survival rate and technical survival rate of peritoneal dialysis patients were analyzed. Results: in this dialysis center, the average age of 184 peritoneal dialysis patients was 53.3 鹵15.3 years old, most of them were distributed in 50-60 years old, the average dialysis age was 15.4 鹵10.3 months, the ratio of male and female was 1: 1.09. The primary diseases were: chronic glomerulonephritis, diabetic nephropathy, hypertensive renal damage, renal tubulointerstitial injury and so on. The mean residual renal function was 4.15 鹵2.78 ml / min, the peritoneal transport function was mainly high average transport, and the incidence of peritonitis was 28.26, April to May and October to December respectively. As of June 30, 2016, 20 out of 184 peritoneal dialysis patients died (10.9%), the causes of death were cardiovascular factor (17 cases), cerebrovascular factor (2 cases), infection factor (1 case), hemoglobin 鈮，

本文編號(hào)：1789492