个体化饮食结构调查和健康教育对控制广东省客家地区血液透析患者高磷血症的初步疗效：一项半随机对照研究

Role of individual nutrition investigation and education for control of hyperphosphatemia in hemodialysis patients in Guangdong Hakkas area： a quasi -randomized control pilot study

目的调查广东省客家地区血液透析人群高磷血症的现况，并探索控制高磷血症的健康教育模式。方法对某县级医院的血液透析患者进行两次连续性横断面调查。第一次调查后，将高磷血症的患者半随机分为常规教育组和个体化教育组。在所有患者进行常规健康教育的基础上，个体化教育组还利用自制调查表了解患者对高磷血症健康知识的知晓情况和饮食习惯，并结合临床指标个体化指导饮食。3个月后进行第二次调查。结果首次调查的46例患者普遍有高磷饮食习惯，43例（93．5％）合并高磷血症。常规教育组和个体化教育组各有15例和25例高磷血症患者完成了两次调查。接受个体化教育后，高磷血症知识的知晓率增加，部分患者改变了饮食习惯。常规教育组血磷水平显著升高，而个体化教育组血磷水平稳定，6例依从性良好的个体化教育患者血磷水平较前下降。结论客家地区血液透析人群高磷血症问题非常严重，高磷饮食习俗是重要原因。个体化饮食健康教育是控制高磷血症经济有效的模式。

Objectives To investigate current condition of hyperphosphatemia and explore a reasonable model for control hyperphosphatemia in hemodialysis patients in Guangdong Hakkas area. Methods A series of 2 cross - sectional investigations in hemodialysis patients in a county - level hospital were performed. After the l st in- vestigation, the patients with hyperphosphatemia were divided into routine education or individual education group in a quasi - randomized manner. All the patients were trained with routine health education, while the patients in indi- vidual education group were investigated for the knowledge about hyperphosphatemia and diet habit through interview questionnaire, and guided for diet management according to the clinical indicators. After 3 - months follow - up, the 2nd investigation was carried out. Results Most of the 46 patients of the 1 st investigation had eating habits of food high in phosphorus and 43 （93.5%） of them were complicated with hyperphosphatemia. Forty patients completed the two investigations, 15 in routine education group and 25 in individual education group, respectively. After trained individually, the awareness rate of hyperphosphatemia information was increased and a part of patients changed eating habits in the individual education group. In the 3 - months follow - up, the serum phosphorus level was increased in the routine education group, stable in individual education group, while decreased in 6 patients with good compliance. Conclusions The hyperphosphatemia is significant in hemodialysis patients in Guangdong Hakkas area, which is attributed to the Hakka cuisine high in phosphorus. Individual diet education is an effective model for hyperphosphatemia control.