Ankur Shah, Osama El Shamy, Christina A Raker, Jeffrey Perl, Susie Hu
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引用次数: 0
摘要
背景：接受维持性透析的患者在心血管（CV）手术后面临高死亡率和并发症。随着腹膜透析（PD）的应用越来越多，了解腹膜透析方式（PD vs.以中心为基础的血液透析[HD]）对心血管手术后预后的影响非常重要。方法：本回顾性队列研究使用2016-2020年全国住院患者样本数据，比较PD和HD患者接受冠状动脉旁路移植术和外科瓣膜手术的结果。采用多变量logistic回归、负二项回归和线性回归模型，调整人口统计学因素、合并症和医院特征。主要结局是住院死亡率，次要结局包括延长通气时间、住院时间和住院费用。结果：共纳入30,155例患者，其中28,015例（92.9%）接受HD治疗，2140例（7.1%）接受PD治疗。与HD相比，PD与较低的住院死亡率（OR 0.61, 95% CI 0.38-0.97）、较短的通气时间（OR 0.51, 95% CI 0.32-0.81）、较短的住院时间（IRR 0.85, 95% CI 0.80-0.91）和较低的住院费用（平均差异为87,172美元，95% CI为113,523美元至- 60,820美元）相关。在PD患者中，术后转变为HD的患者预后较差。结论：在围手术期维持PD可能比HD有好处，包括降低住院费用和改善患者预后。在心血管手术患者的管理中，需要仔细考虑透析方式，以优化临床结果并降低医疗成本。
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