维持性血液透析患者实施个体化营养支持的效果及影响因素分析

Effect and influence factors of individualized nutritional support in maintenance hemodialysis patients

目的评价个体化营养支持对维持型血液透析患者营养改善的效果,并对其影响因素进行分析,为针对性营养干预提供依据。方法选择血液透析患者98例进行自身前后对照,按患者营养支持前的各种指标进行个体化营养支持,比较个体化营养支持前后的各项指标变化情况。营养风险评分与其他因素相关性分析使用Pearson相关系数法,多因素分析使用Logistic回归分析。结果 1个体化营养支持后患者的血红蛋白(Hb)、血清白蛋白(Alb)、蛋白质摄入量、肌酐(Cr)、肱三头肌皮褶厚度(TSF)和上臂肌围(AMC)等均有不同程度提高,胆固醇(TC)、营养风险评分下降(P<0.05);2患者营养风险与体重、民族、并发症、透析时长、血清白蛋白(Alb)、肱三头肌皮褶厚度(TSF)、上臂肌围(AMC)及蛋白摄入量等因素有相关性(P<0.05);3影响患者营养风险评分的独立因素是透析时长、并发症、蛋白摄入量(P<0.05)。结论个性化的营养支持可改善维持性血液透析患者的营养不良状况,但在对患者实施个性化营养支持时,需要关注有并发症、蛋白摄入低及每周透析时间较短的患者,以减少营养不良的发生。

Objective To evaluate the effect of individualized nutritional support on maintenance hemodialysis patients, analyze the influencing factors, and provide basis for the targeted nutrition intervention. Methods Ninety-eight hemodialysis patients were enrolled, who received individualized nutritional support according to the indicators before nutrition support. The changes of the indicators before and after nutrition support were compared. Pearson correlation coefficient was used to analyze the correlation between nutritional risk score and other factors. Logistic regression analysis was applied for used multi-factor analysis. Results ① After individualized nutritional support, Fib, Alb, Cr, TSF, AMC and protein intake were improved, while TC and nutritional risk score were reduced, P〈0.05. ② Nutritional risk was correlated with weight, ethnic, complications, dialysis length, Alb, TSF, AMC and protein intake, P〈0.05. ③ The independent factors of nutritional risk score were dialysis length, complications, protein intake, P〈 0.05. Conclusion Individualized nutritional support can improve nutritional status. We need to pay attention to the patients of complications, low protein intake and weekly dialysis time during maintenance hemodialysis, in order to reduce the occurrence of malnutrition.