本文選題：腹膜透析 + 血液透析��； 參考：《寧夏醫(yī)科大學》2017年碩士論文

【摘要】：目的:比較無尿的維持性血液透析(maintenance hemodialysis,MHD)及持續(xù)不臥床腹膜透析(Continuous Ambulatory peritoneal dialysis,CAPD)患者的臨床特征及預后,為無尿的透析患者的治療提供參考依據(jù)。方法:回顧性納入2008年1月至2015年12月在寧夏醫(yī)科大學總醫(yī)院腎臟內(nèi)科規(guī)律行透析治療(MHD和CAPD)且已無尿(每日尿量100ml)的患者。收集研究對象的一般資料、生化指標及轉歸情況等。比較兩組患者在發(fā)生無尿時的臨床特征,應用Kaplan-Meier法及Cox回歸模型分析患者的生存及相關危險因素。研究終點為:主要終點(全因死亡)。結果:1、共納入234例患者進入本次研究,其中CAPD組患者共152例,男性85例(55.9%),女性67例(44.1%),MHD組患者共82例,男性60例(73.2%),女性22例(26.8%)。兩組患者原發(fā)病構成均以慢性腎小球腎炎居多,其次為糖尿病腎病、高血壓腎損害等,其中CAPD組患者高血壓腎損害所占比例高于MHD組(χ2=5.66,P=0.017)。2、臨床資料比較:CAPD組患者發(fā)生無尿時透析齡、發(fā)生無尿后隨訪時間、BMI、總Kt/V、血鈣、肌酐水平均高于MHD組(P0.05)。CAPD組患者身高、血磷、血清白蛋白、血鉀水平低于MHD組(P0.05)。無尿的CAPD組與MHD組患者發(fā)生無尿時的年齡、收縮壓、舒張壓、體重、白細胞、血紅蛋白、iPTH、血清鐵、甘油三酯、總膽固醇、低密度脂蛋白、高密度脂蛋白、血糖、血鈉、二氧化碳結合力、超敏C反應蛋白水平無明顯差異(P0.05);3、截止研究終點共死亡人數(shù)67例(28.6%),其中CAPD組40例,死亡原因主要為心血管事件14例(35%),全因死亡6例(15%),腹膜炎6例(15%)、腦血管事件6例(15%)、感染4例(10%)、營養(yǎng)不良3例(7.5%)。MHD組總死亡人數(shù)27例,死亡原因主要為心血管事件10例(37.04%),全因死亡8例(29.6%),腦血管事件6例(22.2%),感染3例(11.1%)。兩組間患者心血管事件、腦血管事件、全因死亡、感染引起的死亡率無差異(P0.05);CAPD組患者腹膜炎引起的死亡率明顯高于MHD組患者(P0.05)。4、CAPD組患者發(fā)生無尿后平均生存時間為(23.29±23.58)月,MHD組患者發(fā)生無尿后平均生存時間為(12.26±10.39)月,CAPD組發(fā)生無尿后生存時間長于MHD組患者(P0.05);CAPD組患者無尿后生存率高于MHD組(P0.05);5、經(jīng)多因素Cox回歸分析顯示:年齡、血漿白蛋白、血糖、超敏C反應蛋白是影響無尿的CAPD患者生存時間的危險因素(P=0.000),年齡、收縮壓是影響無尿的MHD組患者生存率的危險因素(P=0.000)。結論:1、MHD組患者較CAPD組發(fā)生無尿的時間更早;而發(fā)生無尿后CAPD患者生存率較MHD高;2、年齡、血漿白蛋白、血糖、超敏C反應蛋白是影響無尿CAPD患者生存率的危險因素,年齡、收縮壓是影響無尿的MHD患者生存率的危險因素。
[Abstract]:Objective: to compare the clinical features and prognosis of maintenance hemodialysis (HD) patients with anuria and continuous Ambulatory peritoneal dialysis (CAD) with continuous ambulatory peritoneal dialysis (PD), so as to provide reference for the treatment of patients with anuria. Methods: from January 2008 to December 2015, the patients with MHD and CAPDwere treated with dialysis from January 2008 to December 2015 in the Department of Renal Medicine, Ningxia Medical University General Hospital and had no urine (100 ml per day). Collect the general data, biochemical indicators and the outcome of the study. The clinical characteristics of patients with anuria were compared and the survival and related risk factors were analyzed by Kaplan-Meier method and Cox regression model. The end point of the study was: main end point (all cause of death). Results two hundred and twenty four patients were included in the study, including 152 patients in the CAPD group, 85 in the male group, 82 in the female group, 60 in the male group and 22 in the female group. The primary components of the two groups were mainly chronic glomerulonephritis, followed by diabetic nephropathy, hypertensive renal damage and so on. The proportion of hypertensive renal damage in CAPD group was higher than that in MHD group (蠂 2 = 5.66). The clinical data were compared with that in MHD group (P 0.05. 05). The clinical data were compared with those in MHD group. The age of dialysis, follow-up time after anuria, total KT / V, serum calcium and creatinine levels were all higher than those in MHD group P0.05.CAPD group. The levels of serum albumin and potassium were lower than those of MHD group (P 0.05). Age, systolic blood pressure, diastolic blood pressure, body weight, white blood cell, hemoglobin CAPD, serum iron, triglyceride, total cholesterol, low density lipoprotein, high density lipoprotein, blood glucose, blood sodium, There was no significant difference in carbon dioxide binding capacity and hypersensitive C-reactive protein level (P 0.05). At the end of the study, 67 patients died, including 40 patients in CAPD group. The main causes of death were cardiovascular events in 14 cases, total death in 6 cases, peritonitis in 6 cases, cerebrovascular events in 6 cases, infection in 4 cases and malnutrition in 3 cases. The total number of deaths in MHD group was 27 cases. The main causes of death were cardiovascular events in 10 cases (37. 04), death in 8 cases (29. 6%), cerebrovascular events in 6 cases (22. 2%) and infection in 3 cases (11. 1%). Between the two groups, cardiovascular events, cerebrovascular events, all due to death, There was no difference in mortality caused by infection. The mortality caused by peritonitis in patients with CAPD was significantly higher than that in patients with MHD. The mean survival time after anuria was 23.29 鹵23.58. The mean survival time of patients with CAPD was 12.26 鹵10.39 months. The survival time after anuria was longer than that in MHD group (P 0.05) and the survival rate was higher than that in MHD group (P 0.05). The age was analyzed by multivariate Cox regression analysis. Plasma albumin, blood glucose and hypersensitive C-reactive protein were the risk factors of survival time in patients with CAPD with anuria. Age and systolic blood pressure were the risk factors for survival of patients with anuria MHD. Conclusion the duration of anuria in CAPD group was earlier than that in CAPD group, and the survival rate of CAPD patients after anuria was 2% higher than that of MHD. Age, plasma albumin, blood glucose and hypersensitive C-reactive protein were the risk factors affecting the survival rate of CAPD patients with anuria. Systolic blood pressure is a risk factor for survival in MHD patients with anuria.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R692.5

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