持续不卧床腹膜透析营养状况的评价与分析

Evaluation and Analysis of Nutritional Status in Continuous Ambulatory Peritoneal Dialysis

目的：以32例持续不卧床腹膜透析患者的营养状况进行评估与影响因素的分析。方法：①采用Young等修订的主观综合性营养评估法（SGA）对腹膜透析患者营养状况进行评估;②采用标准腹膜平衡试验（PET）评估患者的腹膜溶质转运特性;③根据患者24h透出液、尿液,测定其肌酐、尿素氮及蛋白值,计算出尿素清除指数（KT/V）、校正蛋白分解率（nPCR）,并计算残余肾肌酐清除率（rCcr）。结果：①依据SGA评分,CAPD患者营养不良总发生率53.1%;与营养良好组相比,营养不良组患者的Hb、Alb、BUN、Cr、Ch、TG、三头肌褶厚度、髂皮褶厚度低于营养良好组,CRP明显升高;营养不良组水肿发生率明显增高;②按腹膜溶质转运特性划分高转运组和低转运组,高转运组的血清Alb和nPCR显著低于转运组;③营养良好组KT/V、rCcr及残余尿量均高于营养不良组。结论：CAPD患者营养不良发生率高,纠正有关影响因素,有助于改善患者的营养状况。

Objective： To evaluate nutritional status in 32 cases with continuous ambulatory peritoneal dialysis （CAPD） and analyze the influencing factors. Method： ①Patients＇ nutritional status was evaluated by subjective global nutritional assessment （SGA） ;②Standard peritoneal equilibrium tests （PET） was used to evaluate peritoneal transport characteristics; ③We measured patients ＇ creatinine, urea nitrogen and total protein, calculated urea clearance index （KT/V） and rCer, and corrected protein catabolic rate according to their peritoneal effluent and urine in 24h. Result： ①According to SGA score, CAPD patients＇ incidence of malnutrition was 53.1%; compared to patients with good nutrition, malnutrition group had lower Hb, Alh, BUN, Cr, Ch, TG, triceps muscle fold thickness and higher CRP. The incidence of edema was obviously improved; ②patients were divided into high transport group and low transport group according to peritoneal transport characteristics. High transport group＇s Alb and nPCR were obviously lower than low transport group; ③patients with good nutrition had higher KT/V, rCer and residual urine volume than malnutrition group. Conclusion： CAPD patients have high incidence of malnutrition. The correcting of related influencing factors is helpful to the improvement of patients＇ nutritional status.