医护-营养师一体化综合管理模式对高磷血症维持性血液透析患者血磷的影响

Effects of a physician-nurse-dietitian integrated management model education program on serum phosphorus in maintenance hemodialysis patients with hyperphosphatemia

目的评价医护-营养师一体化综合管理模式对高磷血症维持性血液透析(maintenace hemodialysis,MHD)患者血磷的影响。方法选择我院血液透析室2018年9月~2019年3月反复高磷血症MHD患者30例纳入本研究,采用医护-营养师一体化综合管理模式对患者进行干预,干预时间为3个月(90 d),干预前、后对患者高磷血症知识掌握情况、营养状况、饮食摄入、血磷、血钙、钙磷乘积、白蛋白等实验室检查结果进行评估。结果干预后患者的高磷血症知识问卷调查得分较干预前明显升高(P<0.01),血磷水平明显下降(P<0.01),营养状况评估指标以及血钙、白蛋白、甲状旁腺激素(intact parathyroid hormone,iPTH)等实验室检查结果无明显变化。干预后患者饮食中热量无明显变化,蛋白质、磷摄入量、磷/蛋白质比值较干预前明显下降(P<0.05)。结论医护-营养师一体化综合管理模式能够提高MHD患者高磷血症知识水平,降低血磷水平,降低饮食中磷摄入量,且不影响患者营养状况。

Objective To explore the effects of a physician-nurse-dietitian integrated management model education program on serum phosphorous control in maintenance hemodialysis(MHD)patients with hyperphosphatemia.Methods Thirty hemodialysis patients having refractory hyperphosphatemia from September 2018 to March 2019 in Department of Nephropathy of our hospital were recruited in this study.A physician-nurse-dietitian integrated management model was adopted to intervene the patients for 3 months(90 days).The patients'hyperphosphate miarelated knowledge,nutritional status,dietary intake,laboratory test results of serum phosphorous level,serum calcium level and albumin were assessed and compared with those at baseline.Results The score of hyperphosphatemia knowledge questionnaire after intervention was significantly higher than that before intervention(P<0.01),and the serum phosphorous level decreased significantly(P<0.01)after the intervention.The nutritional status assessment indicators,serum calcium,albumin and iPTH level were stable during the study period.Both their dietary calories did not change;while their dietary protein,phosphorous and phosphorous/protein ratio were decreased significantly compared to those before intervention(P<0.05).Conclusions The physician-nurse-dietitian integrated management model education can improve the hyperphosphatemia related knowledge of MHD patients,reduce serum phosphorous level and dietary phosphorous intake without malnutrition.