新增老年维持性血液透析患者的临床特征

    Clinical characteristics of newly increased elderly patients with maintenance hemodialysis

    • 摘要: 目的 探讨单中心新增老年维持性血液透析(MHD)患者的临床特征,为提高本地区慢性肾衰竭的医疗质量提供临床决策依据。方法 选择符合纳入标准的新增MHD患者83例,将年龄≥ 65岁的41例患者设定为老年组,<65岁的42例患者设定为对照组,比较2组患者的原发病、临床及实验室检查指标、血管通路和主要临床表现。结果 老年组患者平均年龄(72.8±4.6)岁,男23例,女18例,男女比例为1.28:1,最常见的原发病为高血压病15例(36.59%),其次为糖尿病12例(29.27%)、原发性肾小球疾病9例(21.95%)。对照组排前3位的原发病依次为原发性肾小球疾病19例(45.24%)、糖尿病8例(19.05%)和多囊肾6例(14.29%),2组原发病构成比差异有统计学意义(P<0.05)。老年组血红蛋白、估算肾小球滤过率较对照组高(P<0.05),舒张压和血磷低于对照组,其差异有统计学意义(P<0.05),而收缩压、血清白蛋白、空腹血糖、低密度脂蛋白、血校正钙、全段甲状旁腺素与对照组无差异。2组首次血液透析血管通路的构成比无差异(P>0.05),多数患者采用中心静脉导管。结论 本中心新增老年MHD患者最常见的原发病为高血压病和糖尿病,其残余肾功能、血红蛋白、血磷和舒张压优于对照组,血管通路的选择和主要临床表现无特殊性,适时透析治疗可取得与中青年患者相似的疗效。

       

      Abstract: Objective To explore the clinical characteristics of newly increased maintenance hemodialysis (MHD) patients in single center, in order to provide decision-making basis for improving the quality of chronic renal failure in the region.Methods Eighty-three newly increased MHD patients conformed to the standard were enrolled in this study. The 41 patients aged over 65 years old were assigned to the elderly group, and the 42 patients aged below 65 years old served as the control group. The primary diseases, clinical and laboratory indicators, vascular access and major clinical manifestations were compared between the two groups.Results The mean age of the 41 elderly patients was (72.8±4.6) years old, (23 males and 18 females) the ratio of male to female was 1.28:1, the most common primary disease was hypertension (n=15, 36.59%), followed by diabetes (n=12, 29.27%) and primary glomerular disease (n=9, 21.95%). The control group ranked the top three primary disease were primary glomerular disease (n=19, 45.24%), diabetes (n=8, 19.05%) and polycystic kidney (n=6, 14.29%). There was statistically significant difference in primary disease composition between the two groups (P<0.05). The hemoglobin and glomerular filtration rate in the elderly group were significantly higher (P<0.05), and the blood phosphorus and diastolic blood pressure were significantly lower than those in the control group (P<0.05). There were no significant differences between the two groups in systolic blood pressure, serum albumin, fasting blood glucose, low density lipoprotein, blood corrected calcium and intact parathyroid hormone. There was no significant difference in the composition of vascular access between the groups for the first-time hemodialysis (P>0.05), and most patients used central venous catheters.Conclusions The most common primary diseases of newly increased MHD patients are hypertension and diabetes in the elderly group. The residual renal function, hemoglobin level, blood phosphorus level and diastolic blood pressure are superior to those in the control group. The selection of vascular access and the main clinical manifestations are not special. The study also enables us to recognize that timely dialysis treatment for elderly patients in the area can achieve similar therapeutic effects to young and middle-aged patients.

       

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