赋能教育模式对血液透析患者钙磷代谢及营养状态的影响

The influence of empowerment education model on calcium-phosphate metabolism and nutritional status in maintenance hemodialysis patients

目的观察赋能教育模式对血液透析伴矿物质及骨代谢异常患者钙磷代谢及营养状态的影响。方法组建赋能教育模式团队,选择2015年6月至2016年6月我院透析中心维持性血液透析(maintenance hemodialysis,MHD)患者60例,赋能教育模式干预12周后,采用自身前后对照的方法,比较患者血钙、血磷、钙磷乘积、全段甲状旁腺激素(intact parathyroid hormone,i PTH)、血红蛋白(hemoglobulin,Hb)、血浆白蛋白(albumin,Alb)、前白蛋白(pre albumin PAB)、肱三头肌皮褶厚度(triceps skinfold thickness,TSF)和上臂中段肌肉周径(mid-arm muscle circumference,MAMC)。结果赋能教育模式后患者血钙、血磷、钙磷乘积、赋能教育模式后患者血钙(t=0.017,P=0.002)、血磷(t=0.368,P=0.005)、钙磷乘积(t=3.089,P≤0.001)、i PTH降低(t=4.216,P=0.004),Hb(t=-1.267,P=0.039)、Alb升高(t=-1.051,P=0.045),TSF升高(t=-2.546,P=0.009),MAMC有升高趋势,但差异尚无统计学意义(t=-1.056,P=0.736)。结论赋能教育模式可改善血液透析伴矿物质及骨代谢异常患者钙磷代谢及营养状态。

Objective To observe the influence of empowerment education model on calcium-phosphate metabolism and nutritional status in maintenance hemodialysis（MHD） patients with abnormal mineral and bone metabolism. Methods We established a team for empowerment education model. A total of 60 MHD patients treated in our blood purification center from June 2015 to June 2016 were enrolled in this study. After the intervention with empowerment education model for 12 weeks, the values of serum calcium and phosphorus, calcium-phosphorus product, i PTH, hemoglobin, plasma albumin, prealbumin, triceps skinfold thickness, and mid-arm muscle circumference were compared before and after the intervention. Results After the intervention of empowerment education model, the levels of serum calcium and serum phosphorus,calcium-phosphorus product, i PTH decreased（t=0.017, P=0.002）, the levels of Hb（t=-1.267, P=0.039）, albumin（t=-1.051, P=0.045） and triceps skinfold thickness（t=-2.546, P= 0.009） increased, but the change of midarm muscle circumference was statistically insignificant（t=-1.056, P=0.736）. Conclusion Empowerment education model can improve calcium-phosphate metabolism and nutritional status in MHD patients with abnormal mineral and bone metabolism.