临床荟萃
臨床薈萃
림상회췌
CLINICAL FOCUS
2015年
1期
71-73,74
,共4页
肾透析%胃肠出血%危险因素
腎透析%胃腸齣血%危險因素
신투석%위장출혈%위험인소
renal dialysis%gastrointestinal bleeding%risk factors
目的：分析维持性血液透析患者并发消化道出血的危险因素。方法血液透析患者并发消化道出血23例（出血组），同期血液透析无出血并发症的患者23例（未出血组），比较两组患者的各项临床指标。调查两组患者使用深静脉置管还是动静脉内瘘进行透析，并比较两组的透析通路间有无差异。调查并比较两组患者有无吸烟、饮酒、进辛辣饮食、消化道基础疾病及非甾体类消炎药（NSAID）服用情况。结果出血组中使用深静脉置管进行血液透析的患者数量高于未出血组，为47．8％（11／23）vs 21．7％（5／23）（P ＜0．05）；出血组的血红蛋白、血细胞比容、血浆白蛋白、血钙水平低于未出血组，差异有统计学意义（均 P ＜0．01）；出血组的血肌酐、尿素氮、血小板计数、凝血酶原时间、部分活化凝血酶原时间与未出血组比较差异无统计学意义（均 P ＞0．05）；出血组在吸烟、饮酒、辛辣刺激饮食、消化道基础疾病与未出血组比较差异有统计学意义（均 P ＜0．01）；NSAID 服用情况两组比较差异无统计学意义（P ＞0．05）。结论使用深静脉置管进行血液透析、贫血、低蛋白血症、血钙低、不良饮食习惯、消化道基础疾病与血液透析患者并发消化道出血有关。
目的：分析維持性血液透析患者併髮消化道齣血的危險因素。方法血液透析患者併髮消化道齣血23例（齣血組），同期血液透析無齣血併髮癥的患者23例（未齣血組），比較兩組患者的各項臨床指標。調查兩組患者使用深靜脈置管還是動靜脈內瘺進行透析，併比較兩組的透析通路間有無差異。調查併比較兩組患者有無吸煙、飲酒、進辛辣飲食、消化道基礎疾病及非甾體類消炎藥（NSAID）服用情況。結果齣血組中使用深靜脈置管進行血液透析的患者數量高于未齣血組，為47．8％（11／23）vs 21．7％（5／23）（P ＜0．05）；齣血組的血紅蛋白、血細胞比容、血漿白蛋白、血鈣水平低于未齣血組，差異有統計學意義（均 P ＜0．01）；齣血組的血肌酐、尿素氮、血小闆計數、凝血酶原時間、部分活化凝血酶原時間與未齣血組比較差異無統計學意義（均 P ＞0．05）；齣血組在吸煙、飲酒、辛辣刺激飲食、消化道基礎疾病與未齣血組比較差異有統計學意義（均 P ＜0．01）；NSAID 服用情況兩組比較差異無統計學意義（P ＞0．05）。結論使用深靜脈置管進行血液透析、貧血、低蛋白血癥、血鈣低、不良飲食習慣、消化道基礎疾病與血液透析患者併髮消化道齣血有關。
목적：분석유지성혈액투석환자병발소화도출혈적위험인소。방법혈액투석환자병발소화도출혈23례（출혈조），동기혈액투석무출혈병발증적환자23례（미출혈조），비교량조환자적각항림상지표。조사량조환자사용심정맥치관환시동정맥내루진행투석，병비교량조적투석통로간유무차이。조사병비교량조환자유무흡연、음주、진신랄음식、소화도기출질병급비치체류소염약（NSAID）복용정황。결과출혈조중사용심정맥치관진행혈액투석적환자수량고우미출혈조，위47．8％（11／23）vs 21．7％（5／23）（P ＜0．05）；출혈조적혈홍단백、혈세포비용、혈장백단백、혈개수평저우미출혈조，차이유통계학의의（균 P ＜0．01）；출혈조적혈기항、뇨소담、혈소판계수、응혈매원시간、부분활화응혈매원시간여미출혈조비교차이무통계학의의（균 P ＞0．05）；출혈조재흡연、음주、신랄자격음식、소화도기출질병여미출혈조비교차이유통계학의의（균 P ＜0．01）；NSAID 복용정황량조비교차이무통계학의의（P ＞0．05）。결론사용심정맥치관진행혈액투석、빈혈、저단백혈증、혈개저、불량음식습관、소화도기출질병여혈액투석환자병발소화도출혈유관。
ABSTRACT:Objective To analyze the risk factors in maintenance hemodialysis patients combined with gastrointestinal bleeding.Methods Twenty-three hemodialysis patients with gastrointestinal bleeding were studied as bleeding group.Over the same period,23 hemodialysis patients without bleeding were studied as non bleeding group to compare all clinical indicators between bleeding group and non bleeding group.The vascular access for hemodialysis used by central venous catheterization or arteriovenous internal fistula were compared between bleeding group and non bleeding group.Risks as smoking,drinking,spicy food,gastrointestinal basic diseases,taking non steroidal anti-inflammatory drugs in bleeding group and non bleeding group were investigated.Results The number of patients in bleeding group increased more significantly than that of non bleeding group,47.8% (11/23)vs 21.7% (5/23)(P <0.05).The level of hemoglobin, hematocrit, plasma albumin, blood calcium in bleeding group reduced more significantly than that in non bleeding group(all P <0.01).There were no significant difference in blood urea nitrogen, serum creatinine,platelet count,prothrombin time,activated partial thromboplastin time between bleeding group and non bleeding group(all P >0.05).There were significant difference in smoking,drinking,spicy food,gastrointestinal basic diseases between bleeding group and non bleeding group (all P <0.01).But there was no significant difference in taking non steroidal anti-inflammatory drugs between bleeding group and non bleeding group(P >0.05).Conclusion Central venous catheterization for hemodialysis, anemia, hypoproteinemia, hypocalcemia, bad eating habit, gastrointestinal basic diseases related with gastrointestinal bleeding in hemodialysis patients.
