夜间长时间血液透析尿毒症患者营养状况的分析

Analysis of nocturnal prolonged hemodialysis(INHD) on nutrition status in uremic patients

目的分析夜间长时间血液透析（INHD）的尿毒症患者的营养状况,探讨INHD对尿毒症患者营养的影响。方法选择2009年1月~2012年3月于我院接受维持性血液透析患者47例为实验组,行INHD治疗（3次/周,7.5 h/次）;选择同期行常规维持性血液透析（3次/周,4 h/次）的患者49例为对照组。对两组患者治疗开始及6个月时的营养学指标[人体测量、实验室检查、主观综合性营养评估（SGA）评分及膳食日记]进行监测和评估。结果①实验组患者上臂周径（MAC）治疗6个月较治疗开始时明显增加,且显著大于同期对照组,差异均有统计学意义（均P〈0.05）;②实验组患者INHD治疗6个月后与治疗开始时比较,体质量（BW）、握力（HGS）及肱三头肌皮褶厚度（TSF）均有不同程度的增加,差异均有统计学意义（均P〈0.05）,但与对照组比较,差异无统计学意义（P〉0.05）;③实验组血磷水平治疗6个月后较较治疗开始时明显下降,且显著低于同期对照组,差异均有统计学意义（P〈0.05或P〈0.01）;④两组间血浆白蛋白（ALB）、血钙及全段甲状旁腺素（iPTH）比较,差异均无统计学意义（P〉0.05）;⑤实验组SGA评分在行INHD治疗6个月时较对照组有明显改善,且显著低于同期对照组,差异均有统计学意义（均P〈0.05）;膳食摄入热量、蛋白质、脂肪、钙、磷等均有所增加,但与对照组比较差异无统计学意义（均P〉0.05）。结论 INHD可增加维持性血液透析患者的营养摄入量,降低患者的血磷水平,从而改善患者的营养状况,具有重要临床价值。

Objective To analyze the status of nutrition in nocturnal prolonged hemodialysis（INHD） patients and to observe the influence of INHD on nutrition status.Methods 47 cases of maintenance hemodialysis patients from January 2009 to March 2012 in our hospital were divided into two groups.47 patients with maintenance hemodialysis in experimental group were received INHD（3 times/week and 7.5 hours each session）,49 patients with maintenance hemodialysis in control group were received conventional hemodialysis（3 times/week and 4 hours each session）.The nutrition status of two groups on various aspects which concluded physical measurements,laboratory tests,SGA and dietary record before and 6 months after the treatment were recorded and estimated.Results ①Mid-upper arm circumference（MAC） of experimental group was found increased 6 months after the treatment and was higher than that of control group in the same period,the differences were all statistically significant（all P 0.05）;②The body weight（BW）,triceps skinfold thickness（TSF） and hand grip strength（HGS） in experimental group 6 months after the treatment were found increased than those before the treatment,the differences were all statistically significant（all P 0.05）,but the difference compared with the control group was not statistically significant（P 0.05）;③the level of serum phosphate was found decreased in experimental group 6 months after the treatment and was lower than that of control group in the same period,the differences were all statistically significant（P 0.05 or P 0.01）;④the differences of ALB,serum calcium and iPTH between two groups were not statistically significant（P 0.05）;⑤Subjective global assessment（SGA） score was found improved in experimental group 6 months after the treatment and was lower than that of control group in the same period,the difference was statistically significant（P 0.05）,dietary intake of energy,protein,fat,calcium and phosphate were found increased in the experimental group,but the differences compared with the control group were not statistically significant（P 0.05）.Conclusion INHD can increase the nutrition intake and reduce the phosphate levels in patients with maintenance hemodialysis,which improves the status of nutrition.