长期血液透析患者营养状况调查及口服营养补充剂的应用

Survey on nutritional status and application of oral nutritional supplement among maintenance hemodialysis patients

目的调查长期血液透析(MHD)患者营养状况,探讨口服营养补充剂(ONS)在改善MHD患者营养状况中的作用。方法2016年1月至2017年12月于宜宾市第二人民医院血液透析中心的MHD患者162例,采用透析客观营养评价法(OSND)评估其营养不良和营养风险发生情况,将筛查出营养不良的患者108例采用随机数字表法分为对照组和ONS组,每组54例。对照组进行传统营养教育,ONS组在此基础上采用ONS替代部分饮食,观察6个月后比较其干预前后营养相关指标。结果利用OSND筛出MHD患者的营养不良发生率为66.7%(108/162),≥60岁营养不良和营养风险发生率为82.8%(72/87),均高于<60岁的49.3%(37/75),差异有统计学意义(χ^2=20.44,P<0.01)。干预前对照组和ONS组体质量(BW)、体质量指数(BMI)、肱三头肌皮褶厚度(TSF)、血清白蛋白(ALB)、Hb、前白蛋白(PA)和转铁蛋白(TF)差异无统计学意义(P>0.05),干预6个月后ONS组BW、TSF、ALB、Hb和TF分别为(53.2±6.5)kg、(10.3±3.1)mm、(39.6±5.6)g/L、(104.5±10.8)g/L、(2.0±0.5)g/L,对照组分别为(50.7±6.0)kg、(9.0±3.0)mm、(35.6±5.5)g/L、(99.7±12.6)g/L、(1.5±0.4)g/L,2组比较差异有统计学意义(t=2.08~5.74,P<0.05或0.01)。干预前2组OSND、GNRI和MIS评分差异无统计学意义(P>0.05),干预后ONS组OSND、GNRI、MIS评分分别为(25.3±1.7)、(92.4±4.5)、(10.9±3.3)分,对照组分别为(24.1±1.9)、(90.4±5.4)、(9.2±3.2)分,2组比较差异有统计学意义(t=3.46、2.09、2.72,P<0.01或0.05)。干预后ONS组和对照组的主观感受评分分别为(10.7±3.5)、(8.9±4.0)分,差异有统计学意义(t=2.49,P=0.01)。ONS组和对照组平均月额外费用分别为(749.2±44.9)、(688.8±254.6)元,差异无统计学意义(t=1.72,P=0.09)。结论长期血液透析患者营养不良发生率高,传统营养教育患者依从性差,而口服营养补充剂配方科学、口味佳,能提高患者依从性和营养状况,为MHD患者科学饮食提供了另一种选择。

Objective To survey the nutritional status of maintenance hemodialysis(MHD)patients and explore the role of oral nutritional supplement(ONS)in improving nutritional status among MHD patients.Methods From January 2016 to December 2017,one hundred and sixty-two MHD patients were selected randomly from hemodialysis centre of No.2 peoples’Hospital and assessed malnutrition incidence by objective score of nutrition on dialysis(OSND).Patients with malnutrition were divided into control group and ONS group randomly,patients in control group were conducted with traditional nutritional education,while patients in ONS group were conducted with ONS as a substitution of diet on the basis of control group.Finally,nutrition-related indexes were observed after 6 months.Results The malnutrition incidence of MHD patients was 66.7%(108/162)screening by OSND,the malnutrition incidence of patients over 60 years old was 82.8%(72/87),significantly higher than below 60 years old,49.3%(37/75)(P<0.05).After 6-month intervention,the differences of nutrition-related physical and laboratory indexes between control group and ONS group was observed[BW:(53.2±6.5)kg vs.(50.7±6.0)kg,t=2.08,P=0.04;TSF:(10.3±3.1)mm vs.(9.0±3.0)mm,t=2.21,P=0.03;ALB:(39.6±5.6)g/L vs.(35.6±5.5)g/L,t=3.74,P<0.01;HB:(104.5±10.8)g/L vs.(99.7±12.6)g/L,t=2.13,P=0.04;TF:(2.0±0.5)g/L vs.(1.5±0.4)g/L,t=5.74,P<0.01],while opposite before intervention(P>0.05).There was no significant difference of OSND,GNRI and MIS scores between control group and ONS group before intervention[OSND:(24.1±1.9)vs.(25.3±1.7),t=3.46,P<0.01;GRNI:(90.4±5.4)vs.(92.4±4.5),t=2.09,P=0.04;MIS:(9.2±3.2)vs.(10.9±3.3),t=2.72,P=0.01],while opposite after intervention(P<0.05).Subjective feeling score of patients in ONS group was significantly higher than control group after intervention[(10.7±3.5)vs(8.9±4.0),t=2.49,P=0.01].The extra cost in control group and ONS group was(688.8±254.6)RMB and(749.2±44.9)RMB respectively with no significance(t=1.72,P=0.09).Conclusion The malnutrition incidence is high among MHD patients,traditional nutrition education takes poor patients compliance,while ONS could improve patients'compliance and nutritional status because of scientific formula and good taste,which provide another diet selection for MHD patients.