对维持性血液透析患者开展身体测量时间的探讨

To study of the best time to evaluate the nutritional status of MHD patients

目的探讨維持性血液透析患者(Maintenance hemodialysis,MHD)评价营养状态时进行身体测量的最佳时间。方法 66例血液透析患者:中青年组53例,老年组13例;2年龄组中又根据透析间期不同的体质量增长率各分为2组分别为:①透析间期体质量增长≤干体质量4.5%(中青年组16例,老年组7例)②透析间期体质量增长>干体质量4.5%(中青年组37例,老年组6例),每个月分别在透析前、后测量患者肱三头肌皮褶厚度(Triceps skinfold,TSF),上臂围(Mid-arm circumference,MAC),计算上臂肌围(Mid-arm muscle circumference,MAMC),分别比较治疗前后数据的差异性。结果①2年龄组全部透析前身体测量数据均值±标准差结果(MAC 29.33±3.48cm;TSF 21.41±6.00mm;MAMC 23.00±2.75cm)均大于透析后测量数据(MAC 28.78±3.40cm;TSF 20.57±5.92mm;MAMC22.52±2.47cm),全部样本透析前后3项身体测量结果统计学分析分别为(MAC t=10.091,P=0.000;TSF t=10.590,P=0.000;MAMC t=3.534,P=0.000);患者上臂围透析前(中青年组29.21±3.44cm、老年组29.81±3.80cm)与透析后(中青年组28.68±3.56cm、老年组29.19±3.69cm)统计学分析(中青年组t=8.437,P=0.000;老年组t=6.009,P=0.000)、肱三头肌皮褶厚度透析前(中青年组21.43±6.06mm、老年组21.34±6.00mm)与透析后(中青年组20.52±5.98mm、老年组20.74±5.88mm)统计学分析(中青年组t=9.865,P=0.000;老年组t=4.242,P=0.000)、上臂肌围透析前(中青年组22.99±2.80cm、老年组23.05±2.68cm)与透析后(中青年组22.50±2.47cm、老年组22.64±2.57cm)统计学分析(中青年组t=2.953,P=0.000;老年组t=5.177,P=0.000);②3项身体测量指标透析前、后差值在不同透析间期体质量增长率分组下均无统计学差异。结论 MHD患者测量以上数据的最佳时间应为透析后、身体无不适(如肌肉紧张,抽筋,低血压等并发症)时进行测量,以避免透析间期的体质量增长的影响,从而合理实行长期的营养评估计划,有效的组织管理营养评估工作,为监测和治疗提供准确的数据。

Objective To explore the best period to evaluate the nutritional status in maintenance hemodialysis （MHD） patients.Methods A total of 66 MHD patients （53 cases in the young and middle age group,and 13 cases in the older age group） were enrolled in this study.Based on the body weight gain in the interval between two sessions of dialysis,each age group was subdivided into two subgroups：patients with body weight gain 〉 4.5% of their dry body weight （37 cases in the young and middle age group,and 6 cases in the older age group）,and those with body weight gain 〈 4.5% of their dry body weight （16 cases in the young and middle age group,and 7 cases in the older age group）.Triceps skinfold （TSF）,mid-arm circumference （MAC）,and mid-arm muscle circumference （MAMC） derived from TSF and MAC were measured and compared every month before and after dialysis.Results ①MAC,TSF and MAMC were significantly larger before dialysis than after hemodialysis （29.33±3.48cm vs.28.78±3.40cm for MAC,t=10.091,P=0.000; 21.41±6.00mm vs.20.57±5.92mm for TSF,t=10.590,P=0.000; 23.00±2.75cm vs.22.52±2.47cm for MAMC,t=3.534,P=0.000） in all patients.MAC,TSF and MAMC values were significantly larger before dialysis than after dialysis in both the young and middle age subgroup and the older age subgroup; MAC value was 29.21±3.44cm vs.28.68±3.56cm （t=8.437,P=0.000） in the young and middle age subgroup,and was 29.81±3.80cm vs.29.19±3.69cm （t=6.009,P=0.000） in the older age subgroup; TSF value was 21.43±6.06mm vs.20.52±5.98mm （t=9.865,P=0.000） in the young and middle age subgroup,and was 21.34±6.00mmin vs.20.74±5.88mm （t=4.242,P=0.000） in the older age subgroup; MAMC value was 22.99±2.80cm vs.22.50±2.47cm （t=2.953,P=0.000） in the young and middle age subgroup,and was 23.05±2.68cm vs.22.64±2.57cm （t=5.177,P=0.000） in the older age subgroup.② No statistical differences were found in the influence of body weight gain on TSF,MAC and MAMC values collected before and after dialysis in the two body weight gain subgroups.Conclusion To avoid the body weight gain in the interval between two dialysis sessions,TSF,MAC and MAMC measurements should be carried out when MHD patients had no complaint of uncomfortable feelings such as muscular tension,cramps and hypotension symptoms after dialysis.These measurements provide accurate data that are helpful for long-term nutritional evaluation and management.