饮食管理在维持性血液透析患者中的应用效果评价

Evaluation of application effect of dietary management in patients with maintenance hemodialysis

目的探讨饮食管理在维持性血液透析患者中的应用效果。方法选取100例维持性血液透析患者作为研究对象,以1∶1的模式随机分为研究组和对照组,每组50例。对照组患者接受常规管理,研究组患者则在对照组基础上联合开展饮食管理。比较两组患者管理前后饮食自我管理能力评分、营养指标[血红蛋白、白蛋白、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、转铁蛋白、体质量指数]水平、炎性因子[超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]水平、肾脏疾病生活质量简表(KDQOL-SFTM)评分,并发症发生情况。结果管理后,两组患者的饮食知识、饮食态度、饮食行为评分及总分均高于本组管理前,且研究组患者的饮食行为评分(30.41±3.26)分、饮食态度评分(17.23±1.55)分、饮食知识评分(17.43±1.25)分及总分(65.07±3.44)分均高于对照组的(23.58±3.37)、(13.37±1.62)、(13.58±1.62)、(50.53±3.36)分,差异具有统计学意义(P<0.05)。管理后,两组患者的血红蛋白、白蛋白、IgA、IgM、转铁蛋白、体质量指数均高于本组管理前,且研究组患者的血红蛋白(149.53±8.26)g/L、白蛋白(39.72±3.43)g/L、IgA(1.43±0.25)g/L、IgM(471.15±28.33)mg/L、转铁蛋白(1.95±0.24)g/L、体质量指数(22.42±2.36)kg/m^(2)均高于对照组的(135.62±9.37)g/L、(36.88±3.54)g/L、(0.89±0.17)g/L、(361.65±30.14)mg/L、(1.59±0.18)g/L、(20.52±2.38)kg/m^(2),差异具有统计学意义(P<0.05)。管理后,两组患者的hs-CRP、IL-6、TNF-α水平均低于本组管理前,且研究组患者的hs-CRP(6.54±1.76)mg/L、IL-6(1.05±0.27)pg/ml、TNF-α(44.56±5.12)ng/L均低于对照组的(8.37±1.64)mg/L、(1.60±0.42)pg/ml、(55.73±6.48)ng/L,差异具有统计学意义(P<0.05)。研究组患者并发症发生率10.00%(5/50)低于对照组的28.00%(14/50),差异具有统计学意义(P<0.05)。管理后,两组患者KDQOLSFTM评分均高于本组管理前,且研究组患者的KDQOL-SFTM评分(70.36±6.23)分明显高于对照组的(61.73±5.86)分,差异具有统计学意义(P<0.05)。结论饮食管理有助于提高维持性血液透析患者饮食自我管理能力,调整机体营养状况及炎性状态,降低并发症发生率,对提高患者生活质量具有积极意义。

Objective To discuss the application effect of dietary management in patients with maintenance hemodialysis.Methods A total of 100 cases of maintenance hemodialysis patients were selected as the research subjects and randomly divided into the research group and the control group in a 1∶1 mode,with 50 cases in each group.Patients in the control group received conventional management,while patients in the research group received dietary management on the basis of the control group.Both groups were compared in terms of score of the dietary self-management ability,nutritional indexes[hemoglobin,albumin,immunoglobulin A(IgA),immunoglobulin M(IgM),transferrin,body mass index],inflammatory factors[high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)]levels,kidney disease and quality of life-short form(KDQOL-SFTM)score before and after management,and the occurrence of complications.Results After management,the scores of dietary knowledge,dietary attitude,dietary behavior and total score of the two groups were higher than those of this group before management;the dietary knowledge score(30.41±3.26)points,dietary attitude score(17.23±1.55)points,dietary behavior score(17.43±1.25)points and total score(65.07±3.44)points of the research group were higher than(23.58±3.37),(13.37±1.62),(13.58±1.62)and(50.53±3.36)points of the control group;the differences were all statistically significant(P<0.05).After management,the hemoglobin,albumin,IgA,IgM,transferrin and body mass index of the two groups were higher than those of this group before management;the hemoglobin,albumin,IgA,IgM,transferrin and body mass index of the research group were(149.53±8.26)g/L,(39.72±3.43)g/L,(1.43±0.25)g/L,(471.15±28.33)mg/L,(1.95±0.24)g/L,(22.42±2.36)kg/m^(2),which were higher than(135.62±9.37)g/L,(36.88±3.54)g/L,(0.89±0.17)g/L,(361.65±30.14)mg/L,(1.59±0.18)g/L,(20.52±2.38)kg/m^(2) of the control group;the differences were all statistically significant(P<0.05).After management,the levels of hs-CRP,IL-6 and TNF-αin the two groups were lower than those before management in this group;the hs-CRP(6.54±1.76)mg/L,IL-6(1.05±0.27)pg/ml and TNF-α(44.56±5.12)ng/L in the research group were lower than(8.37±1.64)mg/L,(1.60±0.42)pg/ml and(55.73±6.48)ng/L in the control group;the differences were all statistically significant(P<0.05).The incidence of complications 10.00%(5/50)in the research group was lower than 28.00%(14/50)in the control group,and the difference was statistically significant(P<0.05).After the management,the KDQOL-SFTM scores of the two groups were higher than those of this group before the management,and the KDQOL-SFTM scores(70.36±6.23)points in the research group were significantly higher than(61.73±5.86)points in the control group,and the differences were all statistically significant(P<0.05).Conclusion Dietary management can help improve the patient's diet self-management ability,adjust the nutritional status and inflammatory state of the body,reduce the incidence of complications,and have positive significance in improving the quality of life of maintenance hemodialysis patients.