基于Omaha系统营养指导对慢性肾衰竭血液透析患者营养指标和肌肉功能及透析充分性影响

Influence of nutritional guidance based on Omaha system on nutritional indexes, muscle function and dialysis adequacy in chronic renal failure hemodialysis patients

目的探究慢性肾衰竭血液透析患者应用基于Omaha系统的营养指导对透析充分性、肌肉功能及营养指标的影响。方法选取2020-08-01-2021-11-30重庆市忠县人民医院肾脏内科慢性肾衰竭血液透析患者96例作为研究对象,对照组48例给予实施常规营养知识宣教,观察组48例给予基于Omaha系统的营养指导,对比2组患者前白蛋白(PA)、白蛋白(ALB)、血红蛋白(HGB)、转铁蛋白(TRF)、血清总铁结合力(TIBC)、肌肉功能(握力体质量指数和肌力分级)、透析充分性[总尿素氮清除指数、总肌酐清除率(Ccr)、标准化蛋白分解代谢率(nPCR)、残余肾小球滤过率(rGFR)]。使用SPSS 26.0对数据进行数据血分析,计数资料用n(%)表示,χ^(2)校验;计量资料用x±s表示,t校验。结果治疗后,观察组患者ALB(38.12±2.81)g/L,高于对照组(36.54±2.70)g/L,差异有统计学意义,t=2.809,P=0.006;HGB(116.03±6.37)g/L,高于对照组(109.25±6.22)g/L,差异有统计学意义,t=5.276,P<0.001;TIBC(57.38±5.85)μmol/L,高于对照组(53.90±5.63)μmol/L,差异有统计学意义,t=2.970,P=0.004;PA(293.35±10.79)mg/L,高于对照组(282.94±10.42)mg/L,差异有统计学意义,t=4.808,P<0.001;TRF(2.35±0.27)g/L,高于对照组(2.18±0.17)g/L,差异有统计学意义,t=3.691,P<0.001;握力体质量指数(46.42±5.74),高于对照组(43.25±5.61),差异有统计学意义,t=2.736,P=0.007;肌力等级评分(4.03±0.51)分,高于对照组(3.61±0.45)分,差异有统计学意义,t=4.278,P<0.001;总Ccr(73.72±28.05)mL/(min/173/m^(2)),高于对照组(69.94±25.88)mL/(min/173/m^(2)),差异无统计学意义,t=0.686,P=0.494;总尿素氮清除指数(2.45±0.69)mL/(min/173/m^(2)),高于对照组(2.02±0.71)mL/(min/173/m^(2)),差异有统计学意义,t=3.009,P=0.003。结论采用基于Omaha系统的营养指导对慢性肾衰竭维持性血液透析患者进行干预,可敏感改善患者营养状态,增强肌肉功能,提升透析充分性。

Objective To investigate the effect of nutritional guidance based on Omaha system on dialysis adequacy,muscle function and nutritional indicators in chronic renal failure hemodialysis patients.Methods Totally 96 patients with chronic renal failure hemodialysis were selected from August 1,2020 to November 30,2021 in the Department of Nephrology,Zhongxian People’s Hospital,Chongqing City as the research objects.48 patients in the control group were given routine nutrition education,and 48 patients in the observation group were given nutritional guidance based on the Omaha system.Prealbumin(PA),albumin(ALB),hemoglobin(HGB),transferrin(TRF),serum total iron-binding capacity(TIBC),and muscle function,including grip body mass index and muscle strength classification,dialysis adequacy which contained total urea nitrogen clearance index,total creatinine clearance(total Ccr),normalized protein catabolism rate(nPCR),residual glomerular filtration rate(rGFR)were compared between the two groups.SPSS26.0was used to analyze the data,the count data was represented by n(%),and theχ^(2)check was performed.The measurement data was represented by x±s,and the t check was performed.Results After treatment,the ALB in the observation group was(38.12±2.81)g/L,higher than that in the control group(36.54±2.70)g/L,the difference was statistically significant(t=2.809,P=0.006);the HGB in the observation group was(116.03±6.37)g/L,higher than the control group(109.25±6.22)g/L,the difference was statistically significant(t=5.276,P<0.001);TIBC in the observation group was(57.38±5.85)μmol/L,higher than the control group(53.90±5.63)μmol/L,the difference was statistically significant(t=2.970,P=0.004);PA in the observation group PA(293.35±10.79)mg/L was higher than that of the control group(282.94±10.42)mg/L,the difference was statistical significance(t=4.808,P<0.001);TRF in the observation group(2.35±0.27)g/L was higher than that in the control group(2.18±0.17)g/L,the difference was statistically significant(t=3.691,P<0.001);the grip strength BMI of the observation group(46.42±5.74)was higher than that of the control group(43.25±5.61),and the difference was statistically significant(t=2.736,P=0.007),and the muscle strength grade score of the observation group was(4.03±0.51)points,higher than that of the control group(3.61±0.45)points,the difference was statistically significant(t=4.278,P<0.001);the total Ccr in the observation group was(73.72±28.05)ml/(min/173/m^(2)),higher than that in the control group(69.94±25.88)ml/(min/173/m^(2)),and the difference was not statistically significant(t=0.686,P=0.494);the total urea nitrogen clearance index in the observation group was(2.45±0.69)ml/(min/173/m^(2))higher than that in the control group(2.02±0.71)ml/(min/173/m^(2)),and the difference was statistically significant(t=3.009,P=0.003).Conclusion The use of nutritional guidance based on the Omaha system to intervene in patients with chronic renal failure on maintenance hemodialysis can sensitively improve the nutritional status of patients,enhance muscle function,and improve dialysis adequacy.