Outcome Study of Patients on Maintenance Hemodialysis Complicated with Acute Respiratory Failure: 1-Year Data from a Medical Center in Central Taiwan

長期透析患者合併急性呼吸衰竭之預後研究：中部單一醫學中心的經驗

陳肅權(Su-Chuan Chen) ； 徐國雄(Kuo-Hsiung Shu) ； 陳呈旭(Cheng-Hsu Chen) ； 吳明儒(Mng-Yu Wu) ； 游棟閔(Tung-Min Yu) ； 莊雅雯(Ya-Wan Chuang) ； 鄭志雄(Chi-Hung Cheng)

《Acta Nephrologica》 24卷1期 (2010/03) Pp. 33-41

摘要

背景：台灣擁有全世界最高的末期腎臟病盛行率與發生率，自從1995年實施全民健保以來，透析費用持續成長，至2007年已占健保年度支出的8%（350億新台幣）。然而，對於長期血液透析病患合併急性呼吸衰竭的預後，目前並沒有太多的研究探討。本研究論文主要就是觀察此一族群的短期與長期預後，以期可以提供更好的照護。
方法：以回顧性病例研究方法，我們分析2006年接受呼吸器治療的透析病人，總共收集了47位病例，以出院時的存活狀態分為存活組與死亡組，比較兩組間的差別。對於存活的病人，我們持續追蹤其存活狀態至2009年1月。
結果：存活組有18位，死亡組有29位病人。統計結果發現兩組間的年齡、性別、既有疾病、心臟－胸廓比例、洗腎原因與時問、住院科別、住院診斷、APACHE Ⅱ分數，住院天數與血液檢查報告並無統計上的差異。若插管原因為肺炎、肺水腫、保護呼吸道的病人，比起敗血症與CPR的病人有較低的住院中死亡率。因CPR而插管的病人其死亡率為敗血症的4.27倍，而敗血症的病人死亡率為肺炎的3.84倍。所有病人的住院累積存活機率為17%，而存活組追蹤的一年存活率為40%。
結論：末期腎臟病病人通常有很多既有疾病，如果合併急性呼吸衰竭，則其預後非常不好。其中肺炎病人的預後相對於其他組的病人來說是比較好的。由於預後不佳，對於這樣的病人，我們可以考慮保守一點的治療。

關鍵字

末期腎臟病 ； 血液透析 ； 呼吸衰竭 ； 預後 ； 死亡率

並列摘要

Background: Taiwan had the highest incidence and prevalence of end stage renal disease (ESRD) patients in the world. However, there were no clinical data on the prognosis of those ESRD patients on maintenance hemodialysis (MHD) who also had acute respiratory failure. The aim of the study was to observe the short-term and long term outcome of this patient group so as to provide a better care.
Methods: This was a retrospective observational cohort study. Forty-seven patients on MHD ＞ 3 months with acute respiratory failure were included in the analysis and stratified according to their hospital mortality, as either survivors or non-survivors. We collected demographic, clinical and biochemical parameters to examine if there was any significant difference.
Results: For the 47 enrolled patients, 18 were in the survivors group and 29 were in the non-survivors group. There was no significant difference in most of the parameters. The patients with sepsis or cardiopulmonary resuscitation (CPR) had a hospital mortality rate of 100%. The survival time was 18 ± 24 days in patients with sepsis and 2.7 ± 5.6 days in patients with CPR. The patients being intuhated for CPR had a hazard ratio for hospital mortality of 4.27 (p＜0.05) compared with those having sepsis. Septic patients had a hazard ratio of 3.84 (p＜0.05) compared with those having pneumonia. The overall cumulative proportional hospital survival was only 17% and the 1-year survival for in-hospital survivors was 40%.
Conclusion: ESRD patients with various comorbidities and acute respiratory failure had very poor outcome. The pneumonia group had relatively better prognosis compared with those with other causes of respiratory failure. Given the ominous prognosis, a more conservative treatment for this specific patient group might be considered.

並列關鍵字

ESRD ； hemodialysis ； respiratory failure ； outcome ； mortality