维持性血液透析患者的营养状况及其影响因素

Nutritional Status of Maintenance Hemodialysis Patients and Its Related Factors

目的了解维持性血液透析患者的营养状况及其影响因素,以提高患者的生活质量和降低病死率。方法采用主观综合营养评估结合实验室生化指标及人体测量指标对66例维持性血液透析患者的营养状况进行综合评价,并观察患者蛋白质摄入量、透析充分性、透析龄、炎症状态及重组人促红细胞生成素(recombinant human erythropoietin,rhEPO)的使用对其营养状况的影响。结果 66例血液透析患者中营养良好者39例(59.1%),轻、中度营养不良者21例(31.8%),重度营养不良者6例(9.1%),总体营养不良的发生率为40.9%。各营养状况组之间血清白蛋白、血红蛋白、肌酐、三头肌皮褶厚度差异有统计学意义(P<0.01或P<0.05);营养良好组蛋白质摄入量和标准蛋白代谢率高于营养不良组(均P<0.01);透析充分、透析龄短于6个月、无慢性炎症及应用rhEPO的患者营养不良的发生率较低。结论血液透析患者营养不良的发生率较高,其发生与蛋白质摄入不足、透析不充分、透析龄较长、发生慢性炎症以及未应用rhEPO等因素有关。

Objective To comprehend the nutritional status and its related factors of maintenance hemodialysis patients for improving the quality of life and reducing the mortality of the affected patients.Methods With the combination of subjective comprehensive nutrition assessment,laboratory biochemical indicators and anthropometric indicators,the nutritional status of 66 maintenance hemodialysis patients were comprehensively assessed.The factors which may affect the patients’nutritional status included dietary protein intake（DPI）,dialysis adequacy,dialysis time,inflammation state and the use of recombinant human erythropoietin（rhEPO） were all observed.Results Of the 66 hemodialysis patients,patients of normal nutrition,mild malnutrition and severe malnutrition accounted for 39（59.1%）,21（31.8%） and 6（9.1%）,respectively.The total incidence of malnutrition was 40.9%.Significant differences were observed among all the nutrition groups in serum albumin,hemoglobin,creatinine and triceps skinfold thickness（P〈0.01 or P〈0.05）.DPI and normalized protein catabolic rate（nPCR） were significantly higher in the normal nutrition group than those in the malnutrition group.Also,patients with dialysis adequacy,dialysis time shorter than 6 months,without chronic inflammation and use of rhEPO had a significant lower incidence of malnutrition.Conclusion Patients with maintenance hemodialysis have a high incidence of malnutrition,which was closely correlated with DPI,dialysis adequacy,dialysis time,chronic inflammation and use of rhEPO.