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应用透析登记系统对维持性血液透析患者临终前终止透析治疗的现况调查 被引量:3

Analysis of dialysis discontinuation and palliative care in maintenance hemodialysis patients by means of dialysis registration system
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摘要 目的 回顾性调查维持性血液透析患者临终前是否终止透析治疗及原因,与相应支持治疗情况.方法 应用上海市透析登记系统及原始存档病历收集1998.1.1至2012.12.31期间在上海交通大学医学院附属仁济医院浦西血液透析中心所有死亡血液透析患者.比较提前终止透析与未终止透析患者性别、年龄、透析龄、原发病、死亡原因等情况,并对提前终止血液透析患者的终止原因及支持治疗进行分析.结果 共收集维持性血液透析死亡患者115例,年龄64.6± 14.2岁,中位透析龄5.4(0.3~21)年,其中男性69例,占60%.原发病前3位分别是:慢性肾小球肾炎(27.8%)、高血压肾硬化(23.5%)、糖尿病肾病(12.2%).死亡原因以脑血管意外(39.1%)、感染(15.7%)、心血管事件(10.4%)、猝死(8.7%)和晚期肿瘤(8.7%)为主.共9例(8%)提前终止透析患者,其中男性7例(77.8%),女性2例(22.2%),终止透析后中位存活天数为8.1天.终止透析原因:4例因晚期肿瘤恶液质终止透析,1例为严重感染,1例为脑血管意外,1例为技术原因无法继续给予肾替代治疗,另2例因经济因素患者本人要求终止透析.9例患者均给予相应的支持治疗措施. 结论 透析登记系统是了解临终期血液透析患者终止透析治疗的有效工具.上海交通大学医学院附属仁济医院浦西血液透析中心数据显示8%的临终患者选择了终止透析,远低于发达国家,提前终止透析组以晚期肿瘤为主要死亡原因. Objective This retrospective and observational study was carried out to analyze the incidence of dialysis discontinuation and the related palliative care in maintenance hemodialysis (MHD) patients.Methods We retrospectively evaluated the patients who died in Pu-Xi Dialysis Unit of Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai,China from Jan.1,1998 to Dec.31,2012.Their sex,age,dialysis age,and primary disease were compared between dialysis discontinuation group and non-discontinuation group.We also collected the information about cause of death and related palliative care.Results A total of 115 MHD patients (male 69 and female 46; mean age 64.6± 14.2 years old; mean dialysis age 5.4 years) who died in this period were analyzed.The major causes of renal failure were chronic glomerulonephritis (27.8%),hypertensive nephrosclerosis (23.5%),and diabetic nephropathy (12.2%).The most common cause of death was cerebrovascular accident (39.1%),followed by sepsis (15.7%),cardiocerebral events (10.4%),sudden death (8.7%),and advanced cancers (8.7%).Of the 9 patients (8%) discounting dialysis,2 were females and 7 were males,and the median living interval after dialysis discontinuation was only 8.1 days.The causes of dialysis continuation included advanced cancers (4 cases),severe infection (one case),cerebral accident (one case),technical difficulties in dialysis (one case),and financial problems (2 cases).Support measures were given to all of the 9 patients after dialysis discontinuation.Conclusions Dialysis registration system is useful for the analysis of patients discounting dialysis.In this series of patients,8% patients discontinued their dialysis,much lower than the ratio in developed countries.The major cause of death in the patients discounting dialysis was advanced cancers.
出处 《中国血液净化》 2014年第1期55-58,共4页 Chinese Journal of Blood Purification
关键词 维持性血液透析 临终关怀 姑息治疗 Maintenance hemodialysis Hospice care Palliative therapy
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参考文献14

  • 1Swidler M. Chapter 37. Dialysis decisions in the elderly patient with advanced CKD and the role of nondialytic therapy. In: Oreopoulos D, Wiggins J, eds. American Society of Nephrology Geriatric Ne- phrology Curriculum. Washington D.C. American Soci- ety of NephrologyEOL:; 2009. http://www, asn-online. org/education/distancelearning/curricula/geriat rics/Chapter37, pdf (accessed July i0, 2013).
  • 2张伟明,钱家麒.国内外透析登记现状[J].中国血液净化,2007,6(9):468-470. 被引量:18
  • 3World Health Organization: WHO Definition of Palli- ative Care, World Health Organization[OL], 2013. Available at: http://www, who. int/cancer/palliative/ definition/en/. Accessed July i0, 2013.
  • 4吕晶,汪涛,尹爱平.临终腹膜透析患者姑息治疗的回顾性分析[J].中国康复医学杂志,2005,20(3):208-210. 被引量:8
  • 5USRDS Annual Data Report Reference Tables. Mortali- ty and causes of death[OL]: table H. 12. http://www. usrds, org/reference, htm; 2012.
  • 6Accessed July I0, 2013. Neu 8, Kjellstrand CM. Stopping long-term dialysis: an empirical study of withdrawal of life-support- ing treatment[J]. N Engl J Med, 1986, 314:14-20.
  • 7Midlothian, VA. Standard Information Management Sys- tem [ESRD Network data- base]. Mid- Atlantic Renal Coalition: 2010.
  • 8Cohen LM, Germain M, Poppel DM, et al. Dialysis discontinuation and palliative care [J]. Am J Kid- ney Dis, 2000, 36:140-144.
  • 9Murray AM, Arko C, Chen S-C, et al. Utilization of hospice in the United States dialysis population [J]. Clinical J Am Soc Nephrol, 2006, i:1248-1255.
  • 10Keely KJ, Roxe DM. Palliative care/hospice and the withdrawal of dialysis [J]. J Palliat Med, 2000, 3: 57-67.

二级参考文献16

  • 1Moss AH, Holley JL, Davison SN, et al. Palliative care [J].American Journal of Kidney Diseases Online,2004,43(1):172-185.
  • 2Weisbord SD, Carmody SS, Bruns FJ, et al. Symptom burden,quality of life, advance care planning and the potential value of palliative care in severely ill haemodialysis patients [J].Nephrol Dial Transplant,2003,18: 1345-1352.
  • 3Joly D, Anglicheau D, Alberti C, et al. Octogenarians Reaching End-Stage Renal Disease: Cohort Study of Decision-Making and Clinical Outcomes[J]. J Am Soc Nephrol,2003,14: 1012-1021.
  • 4Davies S J, Phillips L, Naish PF, et al. Quantifying comorbidity in peritoneal dialysis patients and its relationship other predictors of survival [J]. Nephrol Dial Transplant,2002,17:1085-1092.
  • 5Kutner NG, Zhang R, McClellan WM, et al. Psychosocial predictors of non-compliance in haemodialysis and peritoneal dialysis patients [J]. Nephrol Dial Transplant,2002,17:93-99.
  • 6Salladay SA. Making plans to "allow natural death" [J]. Nursing, 2002,32(5): 24-25.
  • 7Breier SJ. Ethics and Total Parenteral Nutrition: Issues for Intravenous Nurse Professionals[J].Journal of Intravenous Nursing,2000,23(1):52.
  • 8Ward CM.Ethics in surgery[J].Ann R Coll Surg,1994,76:223-227.
  • 9Walsh SM,Schmidt LA. Telephone support for caregivers of patients with cancer [J]. Cancer Nursing, 2003,26(6).
  • 10Davison SN. Pain in hemodialysis patients: Prevalence, cause,severity, and management [J]. Am J Kidney Dis,2003,42:1239-1247.

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  • 1吕晶,汪涛,尹爱平.临终腹膜透析患者姑息治疗的回顾性分析[J].中国康复医学杂志,2005,20(3):208-210. 被引量:8
  • 2张立颖,李亚洁,周宏珍.非恶性病病人的姑息护理[J].护理研究(上旬版),2007,21(2):293-295. 被引量:13
  • 3郭东花,刘文虎,张东亮,郭王,王刚,姜群,廖云,刘桂玲.维持性血液透析和腹膜透析患者死亡原因及预测因素分析[J].中国全科医学,2007,10(9):704-706. 被引量:12
  • 4黎磊石,刘志红主编.中国肾脏病学[M].北京:人民军医出版社,2008,1328-1338
  • 5刘明.护理质性研究[M].北京:人民卫生出版社,2008:39,59.
  • 6李峥,刘宇.护理学研究方法[M].北京:人民卫生出版社,2012:224.
  • 7Xie F,Zhang D,Wu J,et al. Design and implementation of thefirst nationwide, web-based Chinese renal data system (cnrds)[J].BMC Med Inform Decis Mak,2012,12(11) : 1111-1112.
  • 8Brown EA,Chambers EJ,Eggeling C.Palliative care in nephrolo-gy [J]. Nephrol Dial Transplant, 2008,23 (3) ; 789-791.
  • 9O'connor NR,Kumar P. Conservative management of end-stagerenal disease without dialysis:a systematic review [J].J PalliatMed,2012,15(2):228-235.
  • 10Musso CG,Trigka K,Dousdampanis P,et al. Therapeutic alter-natives and palliative care for advanced renal disease in thevery elderly : a review of the literature [ J ]. Int Urol Nephrol,2015,47(4):647-654.

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