CAJ | 학술논문

目的对使用中心静脉长期导管的维持性血液透析的老年患者的生存情况进行分析.方法选取我院肾脏病血液净化科2011年期间收治的建立中心静脉长期导管维持性血液透析治疗患者的老年127例,按置管部位分为颈内静脉置管组和髂外静脉置管组;对所有患者均常规进行血生化检查,并观察导管功能及相关并发症.结果两组患者导管相关感染事件发生率、心血管疾病事件发生率差异无统计学意义,但导管功能不良发生率髂外静脉置管组高于颈内静脉置管组(51.5％比24.5％),差异有统计学意义(x2=8.459,P=0.015).Kaplan-Meier生存曲线结果显示,髂外静脉置管组平均生存时间低于颈内静脉置管组(1.9年比2.5年,x2=10.847,P=o.001);在分别控制导管功能不良与心血管疾病事件因素后,髂外静脉置管组生存时间仍低于颈内静脉置管组(x2=9.915,P=0.002;x2=4.368,P=0.037);多因素Logistic回归分析显示,血红蛋白、肌酐、收缩压、甲状旁腺激素、年龄、导管功能不良是老年维持性血液透析患者发生死亡事件的危险因素.结论使用中心静脉长期导管的老年血液透析患者存在高心血管疾病事件发生率;髂外静脉长期导管功能不良发生率高,同时使用髂外静脉长期导管的老年患者生存率较低.
목적 대사용중심정맥장기도관적유지성혈액투석적노년환자적생존정황진행분석.방법 선취아원신장병혈액정화과2011년기간수치적건립중심정맥장기도관유지성혈액투석치료환자적노년127례,안치관부위분위경내정맥치관조화가외정맥치관조;대소유환자균상규진행혈생화검사,병관찰도관공능급상관병발증.결과 량조환자도관상관감염사건발생솔、심혈관질병사건발생솔차이무통계학의의,단도관공능불량발생솔가외정맥치관조고우경내정맥치관조(51.5％비24.5％),차이유통계학의의(x2=8.459,P=0.015).Kaplan-Meier생존곡선결과현시,가외정맥치관조평균생존시간저우경내정맥치관조(1.9년비2.5년,x2=10.847,P=o.001);재분별공제도관공능불량여심혈관질병사건인소후,가외정맥치관조생존시간잉저우경내정맥치관조(x2=9.915,P=0.002;x2=4.368,P=0.037);다인소Logistic회귀분석현시,혈홍단백、기항、수축압、갑상방선격소、년령、도관공능불량시노년유지성혈액투석환자발생사망사건적위험인소.결론 사용중심정맥장기도관적노년혈액투석환자존재고심혈관질병사건발생솔;가외정맥장기도관공능불량발생솔고,동시사용가외정맥장기도관적노년환자생존솔교저.
Objective To investigate the survival rate in elderly patients with long-term catheters hemodialysis.Methods A total of 127 elderly patients receiving maintained hemodialysis were included in this study.Patients were divided into two groups according to catheter location:long term indwelling internal jugular vein catheter group and long term indwelling vena iliac external catheter group.The baseline anthropometric and laboratory parameters were measured.The catheter dysfunction and catheter related complications were observed.Results The incidence of catheter dysfunction was higher in iliac vein catheter group than in internal jugular vein catheter group (51.5 ％ vs.24.5％,x2 =8.459,P=0.015),and there were no significant differences in the catheter related infection rate and cardiovascular (CVD) event rate between the two groups.Kaplan-Meier survival curves showed that mean survival time was lower in vena iliac external catheter group than in internal jugular vein catheter group (1.9 years vs.2.5 years,x2 =10.847,P=0.001),and still was lower after controlling the catheter dysfunction and cardiovascular events (x2 =9.915,P=0.002;x2=4.368,P =0.037).Multivariate logistic regression analysis showed that levels of hemoglobin,creatinine,systolic blood pressure,parathormone and age were the independent risk factors for mortality in elderly patients with long term catheter hemodialysis.Conclusions There is a high incidence of CVD events in elderly patients with long-term catheter hemodialysis.The incidence of catheter dysfunction is higher and the survival rate is lower in elderly patients with long-term indwelling vena iliac external catheter hemodialysis.