三天饮食记录法在慢性肾脏病患者营养管理中的应用研究

Application of Three-day Diet Records in the Nutrition Management of Chronic Kidney Disease Patients

目的探讨三天饮食记录法在慢性肾脏病(CKD)患者营养管理中的应用价值。方法通过对104例CKD患者进行3个月的营养管理后,分析三天饮食记录的执行者与不执行者饮食医嘱执行正确性及主观综合营养评估法(SGA)评分是否存在差异。结果 104例CKD患者中,31例按要求完成了三天饮食记录,其中2例严格执行医嘱、15例基本执行医嘱、14例部分执行医嘱、无不执行或错误执行医嘱者;73例未完成三天饮食记录,其中5例严格执行医嘱、15例基本执行医嘱,38例部分执行医嘱、15例不执行或错误执行医嘱,完成三天饮食记录者的医嘱执行情况与未完成者比较,差异有统计学意义(χ2=12.428,P=0.006)。完成三天饮食记录者SGA评分A级28例、B级3例、C级0例;未完成三天饮食记录者SGA评分A级54例、B级19例、C级0例,二者差异无统计学意义(χ2=3.488,P=0.062)。结论三天饮食记录对患者营养状态的影响不明显,但有助于提高CKD患者饮食医嘱的执行力度。要想在CKD患者中普及三天饮食记录法还存在一定困难,需要深入分析原因并寻找解决方案。

Objective To explore the value of three-day Diet Records（DRs） in the Nutrition management of chronic kidney disease（CKD） patients.Methods After three months of nutritional management,104 CKD patients were enrolle and divided into DRs-completed group and non-DRs-completed group based on the completion of DRs.The compliance was compared between these two groups.Results Of these 104 patients,31 had completed DRs as required,among whom 2 patients strictly adhered to medical advice,15 basically adhered to medical advice,14 partially adhered to medical advice,and no patient did not adhered to medical advice.Among 73 patients who did not complete DRs,5 patients strictly adhered to medical advice,15 basically adhered to medical advice,38 partially adhered to medical advice,and 15 patient did not adhered to medical advice（χ2=12.428,P=0.006）.However,SGA scores did not show significant difference between the two groups（χ2=3.488,P=0.062）：in the group that had completed DRs,the SGA score was A for 28 cases,B for 3 cases;in the group that did not complete DRs,the SGA score was A for 54 cases and B for 19 cases.Conclusion Although DRs do not remarkably influence the patients nutritional status,it is helpful to improve the compliance.The clinical promotion of DRs still has some difficulties and needs to be properly addressed.