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上海市静安区终末期肾病血液透析患者流行病学调查研究
The epidemiology investigation of end stage renal disease patients receiving hemodialysis in Jing-an district in Shanghai
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DOI:
作者:
顾波
Gu Bo
作者单位:
上海市静安区中心医院
Department of Nephrology, the Central Hospital of Jing-an District, Shanghai 200040, China
关键词:
终末期肾病;血液透析;流行病学
end stage renal disease,hemodialysis,epidemiolog
摘要:
[目的]回顾性研究上海市静安区终末期肾病(end stage renal disease,ESRD)血液透析患者的流行病学特征。[方法] 收集2011年1月~2013年12月上海市静安区中心医院血透室224例ESRD血液透析患者,分析其性别、年龄、原发病的构成、透析持续时间及转归、死亡原因分布、医疗保险模式、主观营养状况评估(SAG)和生活质量的简单评估(包括工作状态、生活自理能力和每年住院次数)。[结果]上海市静安区ESRD血液透析患者的男女之比为1.41:1,平均年龄为(66.51±16.07)岁,以60~79岁比例最高,占47.8%,其次为≥80岁和40~59岁,各占21.9%和21.4% 。原发病构成中慢性肾炎占第一位(35.3%),其次为糖尿病肾病(26.3%)和高血压肾病(21.0%)。近3年糖尿病肾病增长速度最快。224例ESRD血液透析患者中,在透析占43.8% ,死亡占32.6% ,转外院占16.5%,肾移植占1.3% 。其中,持续透析1年以内的患者死亡率最高(42.4%)。〉60岁患者的死亡率高于<60岁患者(P <0.05);糖尿病肾病的死亡比例也最高(37%)。死亡原因以脑血管意外、心血管事件和肺部感染为主。医疗保险模式以大病医保为主,占80.4%;其次为外地报销,占12.9% 。SGA评估中,〉60岁患者营养状况比<60岁患者差(P <0.05)。生活质量评估中,不能自理,和对家人有很强的依赖性,分别占37.9%和22.3%;住院次数,每年0~1次占42.0%,2~5次占30.8%,大于6次以上占27.2%。[结论]上海市静安区ESRD血液透析患者以老年患者居多,糖尿病肾病增长速度最快,尽管以大病医保为主,但两者的营养状况较差、并发症多、自理能力较低、住院次数较多、死亡率较高。
[Objective]Retrospective study epidemiological characteristics of end stage renal disease (ESRD) receiving hemodialysis(HD) in Jing’an district of Shanghai.[Methods]Collecting 224 cases of ESRD patients receiving HD in central hospital of Jing’an district in Shanghai,analyzing their gender,age,primary disease,dialysis duration and outcome,the cause of death,medical insurance pattern,subjective global nutritional assessment(SGA) and simply assessment of quality of life(including work status,self-care ability and hospitalized time per year).[Results]In 224 ESRD patients receiving HD,the ratio of male and femal was 1.41:1,the average age was 66.51±16.07,with the highest portion of 60~79 years old(47.8%),followed by ≥80 years old(21.9%) and 40~59 years old (21.4%).In the primary diseases,the first was chronic glomerulonephritis (35.3%),the second was diabetic nephropathy(26.3%) ,the third was hypertensive nephropathy(21.0%). Diabetic nephropathy was growing fastest nearly three years.Among 224 patients,in dialysis,in death ,turing the outer court and renal transplant each was 43.8%,32.6%,16.5% and 1.3%.The number of death during one year was most,accounted for 42.4%. The mortality rate of 〉60 years old was higher than <60 years old (P <0.05);diabetic nephropathy was the highest proportion of death in the primary deases(37%).The cause of death was given priority to with celebrovascular accident,cardiovascular event and lung infection.Among medical insurance patterns,the serious illness health care was most(80.4%);the field reimbursement was second (12.9%).Among SGA,the nutrition status of >60 years old was worse than <60 years old(P <0.05).Among assessment of life quality,cannot provide oneself and strong dependence of family was 37.9% and 22.3% respectively;about hospital visits, 0~1 times per year, 2~5 times per year and >6 times each was 42.0%,30.8% and 27.2%. [Conclusions]ESRD patients receiving HD in Jing’an district of Shanghai were in the majority with elderly and diabetic nephropathy patients.Although with serious health care was given priority, elderly and diabetic nephropathy patients who were following by poor nutritional status,more complications,low self-care ability and more hospitalization times per year,leaded to highest mortality rate.
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