慢性肾功能衰竭及透析患者营养状况的评价

ASSESSMENT OF NUTRITION IN DIALYSIS PATIENTS AND CHRONIC UREMIC PATIENTS

为了提高尿毒症患者的生活质量，为进行营养治疗提供科学依据，采用多种方法对４０例尿毒症非透析及透析患者进行营养评价。食谱调查显示：每日摄入动物蛋白占总蛋白的比率，在血透组、腹透组均明显高于尿毒症非透析组（Ｐ＜０．０１，Ｐ＜０．０５）；透析患者每日摄入蛋白量和热量均低于推荐摄入量。人体测量显示：３５％透析患者肌肉蛋白储量减少，而尿毒症非透析组则有８０％减少。血浆白蛋白测定血透组明显高于腹透组（Ｐ＜０．０１）；血透组５０％，腹透组８０％及尿毒症非透析组６０％的患者白蛋白低于正常。用尿素氮生成率评价血透、腹透患者的营养状态，６５％血透患者及３７．５％腹透患者为负氮平衡。综合评价表明５８％透析患者有不同程度的营养不良。

Multiple methods were used to assess the nutritional status of 40 uremic nondialysis or dialysis patients in order to improve their living quality as well as to provide scientific basis for nutritional treatment. The investigation of diet diaries revealed that the ratio of animal protein over total protein in food was greater in uremic dialysis patients treated with either hemodialysis or peritoneal dialysis than in the uremic nondialysis patients (P<0.01, P<0.05); the daily intake of total protein in each of three groups was lower than the recommended amount. The anthropometric measurement showed: decreased muscle protein store occurred in 35% of the dialysis patients and 80% of the uremic nondialysis patients. Serum albumin measurement revealed that hemodialysis patients had much higher level than that of peritoneal dialysis patients (P<0.01). 50% of the hemodialysis patients, 80% of the peritoneal dialysis patients and 60% of the uremic nondialysis patients had lower level of serum albumin than normal. Evaluation of nutritional status of hemodialysis patients and peritoneal dialysis patients by means of urea production found that 65% of the hemodialysis patients and 37.5% of the peritoneal dialysis patients were in a status of negative nitrogen balance. According to the results of all the measurements, 58% of the dialysis patients had malnutrition of various degrees.