营养指导联合HAPA模式个性化抗阻运动对维持性血液透析肌少症患者营养指标及生存质量改善作用

Nutritional Guidance Combined with Personalized Resistance Exercise Based on the HAPA Model Improves Quality of Survival and Serum Nutritional Parameters in Patients with Sarcopenia Undergoing MHD

目的探讨营养指导联合健康行动过程取向(HAPA)模式个性化抗阻运动对维持性血液透析(MHD)肌少症患者营养指标及生存质量的改善作用。方法选取2021年6月—2022年3月收治的MHD肌少症120例,根据干预方法不同分为联合组(42例,营养指导联合HAPA模式个性化抗阻运动)和对照A组(40例,营养指导)、对照B组(38例,HAPA模式个性化抗阻运动)。观察比较3组一般资料及干预前、干预3个月后、干预6个月后肌少症病情程度[肌少症筛查问卷(SARC-F)评分]、血清营养指标(血红蛋白、前白蛋白和转铁蛋白)、肢体功能[起立-行走计时试验(TUGT)评分、5次起坐试验(FTSST)、握力试验及Barthel指数评分]及生存质量[肾脏病生存质量量表(KDQOL-SF)评分]。结果干预6个月后,SARC-F评分3组均低于干预前,且联合组低于对照A和B组(P<0.05)。干预3和6个月后,血清血红蛋白、前白蛋白、转铁蛋白、肢体功能和KDQOL-SF评分3组均较干预前升高或改善(P<0.05)。干预3和6个月后,血清血红蛋白、前白蛋白、转铁蛋白联合组高于对照A和B组,对照A组高于对照B组;TUGT评分和FTSST联合组低于对照A和B组,对照A组高于对照B组;握力和Barthel指数评分联合组高于对照A和B组,对照A组低于对照B组;KDQOL-SF评分联合组高于对照A和B组(P<0.05)。结论营养指导联合HAPA模式个性化抗阻运动干预MHD肌少症患者能减轻病情、提高生存质量,这可能与其能改善患者营养状态、恢复患者肢体功能有关。

Objective To investigate the effect of nutritional guidance combined with personalized resistance exercise based on the Health Action Process Approach(HAPA)model on improving nutritional indicators and quality of life in patients with sarcopenia undergoing maintenance hemodialysis(MHD).Methods The clinical data of 120 patients with sarcopenia undergoing MHD from June 2021 to March 2022 were selected,and they were divided into combination group(n=42,nutrition guidance combined with personalized resistance exercise based on HAPA model),control group A(n=40,nutrition guidance)and control group B(n=38,personalized resistance exercise based on HAPA model)according to different intervention methods.The general data,the severity of sarcopenia[Strength,Assistance with walking,Rise from a chair,Climb stairs and Falls(SARC-F)],serum nutritional indexes[hemoglobin(HGB),prealbumin(PA),transferrin(TRF)],limb function[Timed Up&Go Test(TUGT),5-times-sit-to-stand test(FTSST),grip strength test and Barthel index(BI)],quality of life[Kidney Disease Quality of Life Short Form(KDQOL-SF)]before intervention,and at 3 and 6 months after intervention were observed and compared in the three groups.Results At 6 months after intervention,the SARC-F scores of the three groups were lower than those before intervention,and lower in the combination group than in the control groups A and B(P<0.05).At 3 and 6 months after intervention,the serum levels of HGB,PA,TRF,limb function and KDQOL-SF score in the three groups were higher or better those before intervention(P<0.05).At 3 and 6 months after intervention,the serum levels of HGB,PA and TRF in the combination group were higher or better than those in the control groups A and B,and higher in the control group A than in the control group B(P<0.05);the TUGT and FTSST of the combination group were lower than those of the control groups A and B,and lower in the control group B than in the control group A(P<0.05);the grip strength and BI of the combination group were higher than those of the control groups A and B,and lower in the control group A than the control group B;the KDQOL-SF score of the combination group was higher than that of the control groups A and B(P<0.05).Conclusion Nutritional guidance combined with personalized resistance exercise based on HAPA model can effectively alleviate the condition of sarcopenia and improve the quality of life,which may be related to improvement of the nutritional status of patients and restoration of limb function.