桂平市单中心维持性血液透析患者现状分析王福诩;吴芳;苏小芳;梁桂荣;卢冠解;侯佳兴;吴金琼【摘要】目的调查分析广西桂平市人民医院维持性血液透析(maintain hemodialysis,MHD)患者临床资料,为规范临床治疗以及持续质量改进提供数据支持.方法回顾性分析2011～2015年在广西桂平市人民医院透析时间超过3个月MHD患者的临床资料.结果 2015年12月在透患者262例,男155例,女107例,男女比例1.45∶1.原发病构成前3位分别为慢性肾小球肾炎163例(62.21％),糖尿病肾病28例(10.69％),肾结石26例(9.92％).使用自体动静脉内瘘154例(58.78％),使用带绦纶套中心静脉导管74例(28.24％),其余为动静脉直接穿刺或自体动静脉内瘘与带绦纶套中心静脉导管交替34例(12.97％).新农村合作医疗保险241例(91.98％),职工医保11例(4.20％),居民医保9例(3.44％),自费1例(0.38％).新农合医保报销比例约70％(自付约30％),职工医保及居民医保报销比例约50％.高血压治疗达标率为20.61％,贫血治疗的达标率为16.72％,每周透析3次者仅33例(12.60％),乙型肝炎抗原标志物和丙型肝炎抗体的阳性率分别为10.68％和1.14％.近5年病死率分别为11％,16％,14％,10％和17％.在过去的两年中,并发症的发生如脑出血、心力衰竭、消化道出血、导管相关性血流感染及高钾血症无明显改善.在接受抽血检查的部分患者中,钙磷乘积达标率[32.89％(125/255)];全段甲状旁腺激素达标率[17.57％(55/258)];透析充分性达标率(Kt/V≥1.2)[51.24％(103/201)].透析机数量27台,近两年没有增长,而透析人数在不断的增长,2014、2015年透析人数增长率分别为15.84％和11.97％.距离最远患者Kt/V值、透析频率均明显低于距离近者,差异有统计学意义(均P＜0.05).结论本中心MHD患者原发疾病以慢性肾小球肾炎为主;自体动静脉内瘘为最主要的血管通路;医疗保险基本覆盖,以新农合医疗保障为主,职工医保及居民医保报销比例相对低于新农合医保,自付比例仍偏高,患者经济负担较重,可在商业保险方面加强保障.高血压、贫血、骨矿物质代谢紊乱的达标率低;近两年病死率及脑出血、心力衰竭、高钾血症等并发症无明显改善;因透析设备不足无法保障MHD患者充分透析的需求,宜适当增加透析设备并且在MHD患者并发症的处理上加强力度,提高患者依从性,普及规范治疗.%Objective To obtain the data support for standardizing clinical treatment and continuously improving the quality of hemodialysis by investigating the current situation of maintain hemodialysis (MHD) patients in Guiping.Methods We retrospectively analyzed the clinical records of MHD patients treated for more than 3 months from 2011 to 2015 in Guiping.Results A total of 262 MHD patients were enrolled in this study,including 155 males and 107 females with a male/female ratio of 1.45 to 1.The top 3 primary causes for MHD were chronic glomerulonephritis (62.21％),diabetic nephropathy (10.69％) and kidney stones (9.92％).The first used vascular access was arteriovenous fistula (58.78％),and 74 cases were given primary long-term survival of tunneled cuffed hemodialysis catheters (TVCs) (28.24％).New farming and health care was the main payment method.The rate achieved to the recommended levels of hypertension was 20.61％ and the rate achieved to the recommended levels of hemoglobin was 16.72％.There were only 33 cases (12.60％) of the patients who were given dialysis for 3 times per week,and the positive rate of hepatitis B antigen and hepatitis C antibody were respectively 10.68％ and 1.14％.In the last 5 years,the mortality rate was 11％,14％,10％ and 17％ respectively.In the past two years,the incidence of complications such as cerebral hemorrhage,heartfailure,gastrointestinal bleeding,catheter-related bloodstream infection and hyperkalemia was not significantly reduced.The rate achieved to the recommended levels of blood calcium and blood phosphorus was32.89％,17.57％ to iPTH and 5 1.24％to Kt/V≥1.2.Kt/V value and weekly dialysis frequency in the patients with further distance were significantly lower than in those with the closer distance (P＜0.05).Conclusions In our dialysis center,the first three primary causes leading to end-stage renal disease (ESRD) were chronic glomerulonephritis,diabetic nephropathy and kidney stones.The major vascular access was arteriovenous fistula.New farming and health care was the main payment method.The incidence of hypertension,bone and mineral disorders was high,but the control rate was low.In the last two years,there was no significant improvement in mortality rate,cerebral hemorrhage,heart failure and hyperkalemia.The rate achieved to the dialysis frequency and dialysis adequacy is low in the patients with further distance.Treatment compliance and popularly standardized treatment need to be strengthened.【期刊名称】《临床肾脏病杂志》【年(卷),期】2017(017)004【总页数】6页(P234-239)【关键词】维持性血液透析;流行病学;单中心【作者】王福诩;吴芳;苏小芳;梁桂荣;卢冠解;侯佳兴;吴金琼【作者单位】537200桂平,广西壮族自治区桂平市人民医院肾内科;537200桂平,广西壮族自治区桂平市人民医院肾内科;537200桂平,广西壮族自治区桂平市人民医院肾内科;537200桂平,广西壮族自治区桂平市人民医院肾内科;537200桂平,广西壮族自治区桂平市人民医院肾内科;537200桂平,广西壮族自治区桂平市人民医院肾内科;537200桂平,广西壮族自治区桂平市人民医院肾内科【正文语种】中文随着医疗技术的不断进步及医疗保障制度的逐步完善，终末期肾脏疾病(end stage renal disease，ESRD)患者的生存时间和生存质量有了大幅度的改善，新加入维持性血液透析(maintainhemodialysis，MHD)的患者数量也在不断地增加，因此有必要对经济欠发达且交通不便、农村患者占绝大多数的透析中心进行流行病学调查，同时建立数据库。
