饮食指导模式对提高慢性肾脏病患者低蛋白饮食治疗依从性研究

Study on the Diet Guidance Mode to Improve the Compliance of Low- Protein Diet Treatment of Chronic Kidney Disease

目的研究两种不同饮食指导模式对住院慢性肾脏病(CKD)患者低蛋白饮食(LPD)治疗依从性的影响,探讨有利于提高LPD治疗依从性的饮食指导方案。方法确诊CKD3、4期住院患者58例,按区组随机法分为改良模式组(研究组)和一般模式组(对照组)各29例,住院后均接受饮食指导,研究组采用包含食物模具和照片、蛋白质交换份选择表、个性化参考食谱、患者家属旁听等四方面内容的模式;对照组采用包含宣教指导资料、个性化参考食谱、无家属旁听的模式。两组饮食指导后1、2、3d用24h膳食回顾法进行膳食调查,计算并比较患者平均每日热量摄入量(DEI)、蛋白质摄入量(DPI)、优质蛋白质摄入量(HQPI);比较两组DPI与蛋白质推荐摄入量(RPI)的顺应性;并对两组患者的LPD知识和行为态度进行问卷调查评分及分析。结果两组DEI、RPI无显著差异(P=0.910);改良模式组DPI、DPI与RPI的差值显著低于一般模式组(P=0.032,P=0.013),HQPI/DPI≥50%的患者比例显著高于一般模式组(P=0.009),提示改良模式组患者对RPI依从性较高;改良模式组LPD知识与行为态度问卷总评分显著高于一般模式组(P<0.001),两组行为态度良好、行为态度一般和行为态度差的构成有显著差异(P=0.035)。结论包含食物模具和照片、蛋白质交换份选择表、个性化参考食谱和患者家属旁听的改良饮食指导模式可显著提高CKD患者LPD治疗的依从性。

Objective To study the impact of two different diet guidance modes on the LPD treatment compliance of the hospitalized patients with CKD, and explore the diet guidance mode to help improve the LPD treatment. Method 58 cases of hospitalized patients diagnosed with CKD III, IV were randomly and equally divided into the research group and the control group with block randomization. The two groups accepted diet guidance after hospitalization. The research group received the mode including four aspects： food molds and photos, protein exchange portion, personalized reference recipes and the family member observers of patients; The control group received the model including education guidance information and personalized reference recipes without family member observers. The two groups were investigated through 24-hour diet review method after 1, 2, 3d with the diet guidance, the average D EI （daily energy intake）, DPI （daily protein intake） and HQPI （high-quality protein intake） of the patients were calculated and compared; The DPI and the compliances of the RPI （recommended protein intake） of the two groups were compared; The treatment knowledge and behavioral attitude about the LPD treatment of the two groups of patients were scored through questionnaire survey and analyzed. Results There was no significant difference between the DEI and RPI of the two groups （P=0.910）; DPI, the difference of DPI to RPI of the research group were significantly lower than those of the control group （P=0.032,P= 0.013）. The proportion of patients with HQPI/DPI ≥ 50% in the research group was significantly higher than that in control group（P=0.009）, indicating that the patients in research group had better compliance to RPI.The questionnaire score of treatment knowledge and behavioral attitude about the LPD treatment of the research group was significantly increased than that of control group （P〈0.001）; LPD behavior atti- tude in research group is better than control group, the composition of the behavior and attitude style has significant difference （P=0.035）.Conclusion The diet guidance mode including four aspects： food molds and photos, protein exchange portion, personalized reference recipes and the family member observers of patients can significantly improve the LPD treatment compliance of CKD patients.