终末期肾衰维持性血透死亡70例临床分析

目的 探讨终末期肾衰（ESRF）在维持性血液透析（MHD）中的死因及离治对策。方法 对70例在MHD中死亡的ESRF者主要并发症及死因作回顾性分析。结果 近13年来MHD的ESRF患者死亡70例，平均 透析54.7周，93.8次。原发病以慢性肾小球肾炎为主（71.4%)。MHD之前已有高血压，且每次血透前、后伴发高血压次数超过其血透总次数的30%者47例。死因：脑出血27例，心衰23例，心率失常6例，消化道大出血4例，心肌梗死3例，肺结核1例。其中多囊肾中3例（3／4）、痛风性肾病3例（3／3）、高血压肾病中2例（2／3）均死于脑出血。结论 ESRF在MHD中主要死因是脑出血和心衰，高血压是主要危险因素应予良好控制。多囊肾和痛风引起的ESRF在MHD中易因脑出血而死亡。

An analysis of death causes of 70 patients with end-stage renal failure in maintenance hemodialysis

Objective To investigate the death causes of patients with end-stage renal failure(ESRF) in maintenance hemodialysis(MHD) and the strategy in prevention and treatment.Methods The main complications and the death causes of 70 patients with ESRF in MHD were retrospectively analyzed.Results 70 patients with ESRF died in recent 13 years MHD,the mean time of MHD was 54 7 weeks and the mean number of times was 93 8 times. The main primary disease was chronic glomerulonephritis(71 4%) 47 patients were with hypertension before MHD,and the numbers of occurring hypertension before or after every hemodialysis were over 30% of the total hemodialysis times. Death causes: 27 cases died of cerebral hemorrhages, 23 cases heart failures, 6 cases arrhythmias,4 cases gastroenteric hemorrhages,3 cases myocardial infarctions, and 1 case pulmonary tuberculosis. In 4 patients with polycystic kidney 3 cases died of cerebral hemorrhage,the all of 3 patients with gout died of cerebral hemorrhage and 2 cases of 4 patients with hypertension nephropathy died of that Conclusion The main death causes of patient with ESRF in MHD are cerebral hemorrhage and heart failure,the main risk factor of death is hypertension. The patients of ESRF with polycystic kidney and gout easily die of cerebral hemorrhage in MHD.