电子智能辅助工具改善透析患者营养不良及矿物质骨代谢异常的观察研究

Study on the improvement of malnutrition and mineral bone metabolism in dialysis patients by electronic intelligent assistant tools

目的探讨电子智能辅助工具改善营养不良及矿物质骨代谢异常的影响。方法对2018年10月~2019年10月在陆军军医大学附属大坪医院透析治疗的136名存在矿物质骨异常的患者,采用单双数字随机法,分为对照组(传统管理组)和研究组(电子智能辅助工具干预组)。对照组:给予常规透析诊疗及宣教指导。研究组:在常规透析治疗和护理基础上将电子辅助工具融入透析患者营养指导。12月后检测血红蛋白、白蛋白、营养不良炎症评分(malnutrition inflammation score,MIS)量表评估、血钙、磷、甲状旁腺激激素(intact parathyroid hormone,iPTH)水平及达标率的变化。结果入组12个月后研究组白蛋白(t=-3.113,P=0.003)、血红蛋白(t=-3.176,P=0.002)高于对照组;研究组MIS评分低于对照组(t=2.486,P=0.024);2组复合透析方式(χ^2=0.762,P=0.437)、使用非含钙磷结合剂(χ^2=0.697,P=0.680)、活性维生素D(χ^2=0.029,P=0.500)和红细胞生成素使用(χ^2=0.299,P=0.136)的患者人数无统计学意义;研究组的血钙达标率57.4%,显著高于对照的30.9%(χ^2=10.206,P=0.002);研究组的血磷水平明显低于对组组(t=2.170,P=0.043),达标率显著高于对照组(χ^2=7.909,P=0.007);研究组的全段甲状旁腺激素平均水平低于对照组的平均水平(t=2.865,P=0.005);研究组钙磷乘积平均水平(3.47±0.73)低于对照组(4.89±0.88),有统计学差异(t=2.610,P=0.016)。结论将电子辅助工具融入透析患者饮食管理可以改善透析患者的钙磷代谢紊乱和营养不良。

Objective To explore the effects of electronic intelligent assistant tools on improving malnutrition and mineral bone metabolism in dialysis patients.Methods A total of 136 patients with mineral bone abnormalities and treated with dialysis in our hospital from Oct.2018 to Oct.2019 were divided into a control group(traditional management group)and a research group(intervention by electronic intelligent assistant tools)by using the single and double number random method.Electronic intelligent assistant tools were integrated into the nutrition management of dialysis patients.In control group,conventional dialysis treatment,standard medication and auxiliary education and guidance are given;in research group,electronic intelligent assistant tools were integrated into nutrition guidance in addition to the conventional dialysis treatment and nursing.After 12 months,hemoglobin,albumin,malnutrition inflammation score(MIS),blood calcium,phosphorus and iPTH levels and their compliance rates were determined.Results After the enrollment for 12 months,albumin(t=-3.113,P=0.003)and hemoglobin(t=-3.176,P=0.002)were significantly higher in research group than in control group;the MIS score was significantly lower in research group than in control group(t=2.486,P=0.024).The compound dialysis modalities(χ^2=0.762,P=0.437),and use of non-calciumphosphate-containing binders(χ^2=0.697,P=0.680),active vitamin D(χ^2=0.029,P=0.500)and erythropoietin(χ^2=0.299,P=0.136)had no significant differences between the two groups.The compliance rate of serum calcium was 57.4%in research group,significantly higher than that(30.9%)in control group(χ^2=10.206,P=0.002).Serum phosphorus was significantly lower in research group than in control group(t=2.170,P=0.043),and the compliance rate of serum phosphorus was significantly higher in research group than in control group(χ^2=7.909,P=0.007).The average level of iPTH was lower in research group than in control group(t=2.865,P=0.005).The average level of calcium-phosphorus product was(3.47±0.73)in research group,lower than that(4.89±0.88)in control group(t=2.610,P=0.016).Conclusion Use of electronic intelligent assistant tools for the management of diet can improve calcium and phosphorus metabolism disorders and malnutrition in dialysis patients.