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目的 研究长期腹透患者临床转归,分析其临床特点。方法 对本院1994年1 月至2003年8月腹透龄超过3年以上的58例腹透患者进行分析。根据其临床转归分为继续腹 透组、转向移植组、转向血透组及死亡组。比较各组间近期营养指标(半年以内血清白蛋白水 平)、近期透析充分性指标(Kt／V、C(?)r)、水清除指标及残肾功能等临床特点。对死亡组同时做回 顾性前后自身对照研究(死亡前半年以内与死亡前1年资料比较)。对继续腹透组回顾性分析比 较1年前资料,并前瞻性追踪随访1年。结果 死亡组总Kt／V显著低于其余3组(P<0．05); 总C(?)r显著低于继续腹透组(P<0．01)。继续腹透组、移植组及血透组3组间总Kt／V、总C(?)r及 血清白蛋白水平差异无统计学意义。血透组水清除指标显著低于继续腹透组及移植组;继续腹 透组水清除指标稍高于死亡组但无显著性差异。死亡组近期总Kt／V显著低于死亡前1年总 Kt／V(P<0．05);近期总C(?)r显著低于死亡前1年总C(?)r(P<0．01)。继续腹透组近期总Kt／V及 总C(?)r与1年前及1年后指标比较差异均无统计学意义,但残肾Kt／V或残肾C(?)r随时间推移 而显著下降(P<0．05)。继续腹透组残肾Kt／V或残肾C(?)r显著高于死亡组及血透组(P< 0．05)。死亡组血清白蛋白水平较其余3组降低但差异无统计学意义。死亡组13例中有7例死 于心脑血管疾病。结论 腹透3年以上患者大部分仍可继续腹透。透析不充分是长期腹透患者 死亡的重要原因。死亡的病因主要为心脑血管疾病。残肾功能可影响长期腹透患者的转归。
Objective To study the clinical outcome of patients with long-term peritoneal dialysis and analyze its clinical features. Methods From January 1994 to August 2003 in our hospital, 58 patients with peritoneal dialysis over 3 years were analyzed. According to their clinical outcomes are divided into continuing peritoneal group, the steering group, the hemodialysis group and the death group. Compare the recent nutritional indicators (serum albumin within six months), the recent dialysis adequacy indicators (Kt / V, C (?) R), water removal indicators and residual renal function and other clinical features. A retrospective self-control study was also performed on the death group (comparison of data from the first year before death to that of the first year before death). A retrospective analysis of continuing peritoneal dialysis group compared 1 year before the data and prospective follow-up of 1 year. Results The total Kt / V of death group was significantly lower than that of the other three groups (P <0.05). The total C (r) r was significantly lower than that of the continuous peritoneal dialysis group (P <0.01). There was no significant difference in the total Kt / V, total C (?) R and serum albumin between the three groups in peritoneal dialysis group, transplantation group and hemodialysis group. The index of water clearance in hemodialysis group was significantly lower than that in the group of continue peritoneal dialysis and transplantation; the index of water clearance in peritoneal dialysis group was slightly higher than that in the death group, but there was no significant difference. The total Kt / V in the death group was significantly lower than that in the first year before death (P <0.05), and the total C (r) r in the death group was significantly lower than that in the first year before death (P <0.05) .01). There was no significant difference in the total Kt / V and total C (?) R in the continuous peritoneal dialysis group compared with those of 1 year before and after 1 year, but Kt / V or residual kidney C But decreased significantly (P <0.05). The residual Kt / V or residual kidney C (?) R in the peritoneal dialysis group was significantly higher than that in the death group and the hemodialysis group (P <0.05). Serum albumin in the death group was lower than the other three groups, but the difference was not statistically significant. Thirteen of the 13 deaths died of cardiovascular disease. Conclusion The majority of patients with peritoneal dialysis more than 3 years can still continue peritoneal dialysis. Insufficient dialysis is an important cause of death in long-term peritoneal dialysis patients. The main cause of death is cardiovascular and cerebrovascular diseases. Renal function can affect the outcome of long-term patients with peritoneal dialysis.