本文選題：終末期腎病 + 血液透析　； 參考：《上海醫(yī)學(xué)》2015年01期

【摘要】：目的回顧性調(diào)查上海市靜安區(qū)行血液透析治療的終末期腎病(ESRD)患者的流行病學(xué)特征。方法收集2011年1月—2013年12月在上海市靜安區(qū)中心醫(yī)院血液透析室行血液透析治療的ESRD患者224例,分析其性別、年齡、原發(fā)病構(gòu)成、不同透析持續(xù)時間患者的轉(zhuǎn)歸、死亡原因分布、醫(yī)療保險模式、主觀營養(yǎng)狀況評估(SGA)和生活質(zhì)量的簡單評估(包括工作狀態(tài)、生活自理能力和每年住院次數(shù))。結(jié)果上海市靜安區(qū)行血液透析治療ESRD患者的男女之比為1.41∶1,平均年齡為(66.5±16.1)歲,其中60~79歲者占49.1%。原發(fā)病構(gòu)成中慢性腎炎占第1位(35.3%),其次為糖尿病腎病(26.3%)和高血壓腎病(21.0%)。近3年新增加的行血液透析治療ESRD患者中,糖尿病腎病與慢性腎炎同居第1位(均占30.2%),其次為高血壓腎病(19.8%),但三者間構(gòu)成比的差異無統(tǒng)計學(xué)意義(P=0.642)。224例行血液透析治療的ESRD患者的血液透析持續(xù)時間均≥3個月,仍在上海市靜安區(qū)中心醫(yī)院繼續(xù)行血液透析者占43.8%,死亡患者占32.6%,轉(zhuǎn)上海其他醫(yī)院者占16.5%,腎移植者占1.3%。其中,透析3個月~1年的患者最多(59例),病死率(42.4%)也最高(P值均0.05)。各種死亡原因中≥60歲患者的構(gòu)成比均顯著高于60歲患者(P值均0.05)。糖尿病腎病患者總體病死率最高(37.0%,27/73),其次為慢性腎炎(24.7%,18/73)和高血壓腎病患者(23.3%,17/73,P值均0.05)。死亡原因以腦血管卒中、心血管事件和肺部感染為主。醫(yī)療保險模式以重大疾病醫(yī)療保險為主(占80.4%),其次為外地報銷(占12.9%)�！�60歲患者的輕-中度營養(yǎng)不良和重度營養(yǎng)不良發(fā)生率均顯著高于60歲患者(P值均0.05)。生活質(zhì)量評估中,不能自理和自理但依賴家人分別占37.9%和22.3%;住院次數(shù)0~1次/年94例(42.0%),2~5次/年69例(30.8%),≥6次/年61例(27.2%)。結(jié)論上海市靜安區(qū)行血液透析治療的ESRD患者以老年患者居多,新增糖尿病腎病病例數(shù)增長速度最快,盡管以重大疾病醫(yī)療保險為主,但患者的營養(yǎng)狀況較差、并發(fā)癥多、自理能力較差、住院次數(shù)較多、病死率較高。
[Abstract]:Objective to investigate the epidemiological characteristics of end-stage renal disease (ESRD) treated with hemodialysis in Jing'an District of Shanghai. Methods from January 2011 to December 2013, 224 ESRD patients who were treated with hemodialysis in the hemodialysis room of Central Hospital of Jing'an District, Shanghai, were collected and their sex, age, primary disease composition and outcome of patients with different duration of dialysis were analyzed. Distribution of causes of death, medical insurance model, subjective nutritional status assessment (SGA) and simple assessment of quality of life (including work status, self-care ability and number of hospitalizations per year). Results the male / female ratio of hemodialysis for ESRD patients in Jing'an District of Shanghai was 1.41: 1, with an average age of 66.5 鹵16.1 years. Chronic glomerulonephritis was the first of the primary diseases, followed by diabetic nephropathy (26.3) and hypertension nephropathy (21.0). In the last three years, the newly added hemodialysis treatment for ESRD patients, Diabetic nephropathy and chronic glomerulonephritis cohabited in the first place (30.2%), followed by hypertension nephropathy (19.8%). However, there was no significant difference in the composition ratio between the three groups. The duration of hemodialysis was more than 3 months in ESRD patients who were treated with hemodialysis. 43.8patients were still undergoing hemodialysis, 32.6patients died, 16.5patients were transferred to other hospitals in Shanghai, and 1.3patients received kidney transplantation. Among them, there were 59 cases of hemodialysis from 3 months to 1 year, and the mortality rate was 42.4% (P = 0.05). The constituent ratio of patients aged 鈮，

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