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尿毒症血液透析合并心功能不全患者并发胃肠反应及营养不良的因素
陆银凤,颜梅芳,仇何芬,杨晨,袁晓晨,周艳
0
(扬州大学附属医院血液透析室;扬州大学附属医院心内科)
摘要:
【摘要】 目的 探讨尿毒症血液透析合并心功能不全患者胃肠道症状及营养不良发生状况及其影响因素。 方法 选取2017年3月~2018年8月扬州大学附属医院收治的尿毒症血液透析合并心功能不全患者100例,根据有无并发胃肠道症状,分为胃肠症状组(76例)、无胃肠症状组(24例),根据有无营养不良分为营养不良组(51例)及无营养不良组(49例)。对患者的相关血生化指标进行检测,同时采用回顾性分析方法收集患者的一般资料及临床资料,采用多因素Logistic回归分析方法对影响尿毒症血液透析合并心功能不全患者并发胃肠道症状及营养不良的影响因素进行分析。 结果 100例尿毒症血液透析合并心功能不全患者中并发胃肠道症状76例(76.00%)、无胃肠道症状24例(24.00%),其中以消化不良综合征为主(48.00%);并发营养不良51例(51.00%)、无营养不良49例(49.00%)。单因素回归分析结果显示,尿毒症血液透析合并心功能不全患者有无并发胃肠道症状与患者性别、年龄、体重指数(BMI)、血红蛋白(HB)水平、胆固醇(TC)、甲状旁腺激素水平、血清红细胞压积(HCT)、服药片数、糖皮质激素使用史、透析时间、残余肾kt/v水平以及合并糖尿病有关(P<0.05);有无并发营养不良与患者年龄、透析时间、尿素清除指数、合并糖尿病、血清C反应蛋白(CRP)、血清前蛋白(SPA)、血清白蛋白(ALB)、HB以及TC水平有关(P<0.05);多因素Logistic回归分析结果显示,女性患者、甲状旁腺激素水平以及合并糖尿病为影响尿毒症血液透析合并心功能不全患者并发胃肠道症状的独立危险因素(P<0.05);而长时间透析、高血清CRP水平、低血清ALB水平、低尿素清除指数以及高年龄为影响尿毒症血液透析合并心功能不全患者并发营养不良的独立危险因素(P<0.05)。 结论 性别、甲状旁腺激素水平、服药片数、糖皮质激素使用史、透析时间、残余肾kt/v水平以及合并糖尿病有关为尿毒症血液透析合并心功能不全患者发生胃肠道症状的独立影响因素;高年龄、长时间透析、低尿素清除指数以高血清CRP水平是尿毒症血液透析合并心功能不全患者发生营养不良的独立影响因素。
关键词:  尿毒症  血液透析  心功能不全  胃肠道症状  营养不良  影响因素
DOI:
基金项目:江苏省卫计委指导性课题
Analysis of factors associated with gastrointestinal reactions and malnutrition in patients with uremia complicated with hemodialysis and cardiac insufficiency
LU Yinfeng,YAN Meifang,QIU Hefen,YANG Chen,YUAN Xiaochen,ZHOU Yan
(Hemodialysis Room, The Affiliated Hospital of Yangzhou University;Department of Cardiology, The Affiliated Hospital of Yangzhou University)
Abstract:
【Abstract】 Objective To investigate the gastrointestinal symptoms and malnutrition in uremic hemodialysis patients with cardiac insufficiency and its influencing factors. Methods From March 2017 to August 2018, 100 patients with uremic hemodialysis and cardiac insufficiency were divided into gastrointestinal symptoms group (76 cases), nongastrointestinal symptoms group (24 cases), malnutrition group 511 cases) and nonmalnutrition group (49 cases). Relevant blood biochemical indicators were tested in each group. General and clinical data of patients were collected by retrospective analysis. The influencing factors of gastrointestinal symptoms and malnutrition in uremic hemodialysis patients with cardiac insufficiency were analyzed by multivariate logistic regression analysis. Results Among 100 uremic hemodialysis patients with cardiac insufficiency, 76 (76.00%) had gastrointestinal symptoms and 24(24.00%) had no gastrointestinal symptoms. The main symptoms were dyspepsia syndrome (48.00%). 51 (51.00%) were malnutrition patients and 49 (49.00%) were nonmalnutrition patients. The results of univariate regression analysis showed that whether there were gastrointestinal symptoms in uremic hemodialysis patients with cardiac dysfunction, and the sex, age, body mass index (BMI), age, hemoglobin (HB) level, total cholesterol (TC), parathyroid hormone (PTH), hematocrit (HCT), administration. The number of tablets, history of glucocorticoid use, dialysis time, kt / V level of residual kidney and diabetes mellitus were related. Multivariate logistic regression analysis showed that female patients, high thyroid hormone level and diabetes mellitus were independent risk factors for gastrointestinal symptoms in uremic hemodialysis patients with cardiac insufficiency(P<0.05), while longterm dialysis, high serum CRP level, low serum ALB level, low urea clearance index and high age were independent risk factors for uremic hemodialysis. Independent risk factors for malnutrition in patients with cardiac insufficiency (P<0.05). Conclusion Sex, parathyroid hormone level, the number of tablets, glucocorticoid use history, dialysis time, kt / V level of residual kidney and diabetes mellitus are the main influencing factors of gastrointestinal symptoms in uremic hemodialysis patients with cardiac insufficiency. High age, long time dialysis, low urea clearance index and high serum CRP level are the main influencing factors of malnutrition in uremic hemodialysis patients with cardiac insufficiency.
Key words:  Uremia  Hemodialysis  Cardiac insufficiency  Gastrointestinal symptoms  Malnutrition  Influencing factors

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