维持性血液透析患者上消化道出血相关因素剖析.docVIP

维持性血液透析患者上消化道出血相关因素剖析 　　【摘要】 目的：探讨维持性血液透析患者并发上消化道出血的相关因素与防治。方法：将286例维持性血液透析患者分为两组，合并上消化道出血者为出血组，共71例，未发生上消化道出血者为对照组，共215例。收集两组患者的基本资料及各项实验室指标，并对相关指标进行分析。结果：出血组在血红蛋白、肾功能改变、二氧化碳结合力、血钙、血磷、全段甲状旁腺激素、血白蛋白及透析充分性等方面与对照组比较差异有统计学意义（P0.05）。Logistic回归分析显示高磷和继发性甲状旁腺功能亢进是上消化道出血发生的独立危险因素。结论：贫血、酸中毒、低钙、高磷、继发性甲状旁腺功能亢进、营养不良、透析时肝素用量及透析不充分等因素为维持性血液透析患者上消化道出血的危险因素，其中高磷及继发性甲状旁腺功能亢进为独立危险因素，在临床工作中应积极防治透析患者的营养不良，纠正贫血、钙磷失衡及充分透析等以积极防治上消化道出血。 　　【关键词】 血液透析； 上消化道出血； 危险因素 　　【Abstract】 Objective：To investigate the correlation factors and prevention of upper digestive tract bleeding in patients undergoing hemodialysis.Method：Taking 71 patients with upper digestive tract bleeding in 286 patients treated with hemodialysis as the bleeding group，other 215 patients without upper digestive tract bleeding as the control group.For the two groups，the baseline characteristics and laboratory measurements were collected and analyzed.Result：The bleeding group had marked differences on hemoglobin，renal dysfunction，carban dioxide-combining power，calcemia，phosphorus，intact parathyroid hormone，albumin in blood and dialysis adequacy during hemodialysis etc compared with the control group （P0.05）.Multivariable logistic regression analysis showed that hyperphosphatemia and secondary hyperparathyroidism were independent risk factors for upper digestive tract bleeding.Conclusion：Anemia，acidosis，hypocalcemia，hyperphosphatemia，secondary hyperparathyroidism，malnutrition，using heparin when dialyzing and dialysis inadequacy are the risk factors for upper digestive track bleeding in patients undergoing hemodialysis.Among them，hyperphosphatemia and secondary hyperparathyroidism are the independent risk factors.Clinically malnutrition，calcium and phosphorus imbalance and dialysis inadequacy should be prevented actively to prevent upper gastrointestinal bleeding. 　　【Key words】 Hemodialysis； Upper digestive track bleeding； Risk factor 　　上消化道出血在维持性血液透析患者中非常常见，尤其是上消化道大出血是内科危急重症之一，常危及患者生命。因此，探讨维持性血液透析患者上消化道出血的相关因素，对防治此类患者上消化道出血