综合性营养评估法在腹透患者中的应用

The application of global nutritional assessment on patients with peritoneal dialysis

目的应用综合性营养评估法（ｇｌｏｂａｌｎｕｔｒｉｔｉｏｎａｌａｓｅｓｍｅｎｔ，ＧＮＡ）对腹透患者的营养进行评估。方法建立了由１３项主客观评价指标组成的ＧＮＡ，对４４例腹透患者进行营养评价。同时观察了营养与透析充分性的关系及ＤＡＰＤ（每日４袋，夜间停透）与ＣＡＰＤ间营养与充分性的比较。结果（１）营养不良发生率为４３２％，８项营养指标与ＧＮＡ相关。（２）Ｋｔ／Ｖ和Ｃｃｒ均与Ａｌｂ、前白蛋白（ＰｒｅＡ）等营养指标无关，在营养良好与不良组比较中亦无显著性差异。（３）ＤＡＰＤ组患者的Ｋｔ／Ｖ、Ｃｃｒ、体重和残肾功能（ＲＲＦ）均明显差于ＣＡＰＤ组。结论ＧＮＡ对腹透患者具有良好的营养评价作用，近半数的腹透患者在透析过程中发生营养不良。透析充分性与营养并不始终相关。无论营养或透析充分性，ＤＡＰＤ组均差于ＣＡＰＤ组。

Objective To assess nutritional status of peritoneal dialysis(PD)patients withglobal nutritional assessmentand investigate the relationship between nutrition and adequacy. MethodsAglobal nutritional assessmentwas made,including 13 variables derived from SGA,anthropometry and biochemistry.The nutritional status with it and dialysis adequacy with Kt/V and Ccr were examined in 44 PD patients. Results (1)19 patients(432%)were malnurished.A statistical analysis indentified that 8 variables were correlated with global nutritional assessment.(2)Both Kt/V and Ccr were not correlated with nutritional indices except the correlation between PCRN and Kt/V.Meanwhile,there was no difference between nourished and malnourished patients on Kt/V and Ccr.(3)Patients of DAPD had lower body weightRRFKt/V and Ccr level than those of CAPD. Conclusion Global nutritional assessment is effective.Almost half of the patients of PD were malnourished.Adequacy is not always correlated with nutritional status.DAPD maybe one of high risk factors on PD failure.