个体化饮食护理对维持性血液透析患者免疫功能的影响

Effect of individualized diet nursing on immune function in patients with maintenance hemodialysis

目的探讨个体化饮食护理对维持性血液透析(MHD)患者免疫功能的影响。方法选取2016年1月至2020年12月于本院实施MHD的80例尿毒症患者,依据入院编号的奇偶性将其分为对照组(常规护理)与观察组(常规护理+个体化饮食护理),每组40例。比较两组的护理效果。结果透析后30 d,观察组的白细胞分化抗原4阳性(CD4+)、CD4+CD25+、白细胞分化抗原4阳性/白细胞分化抗原8阳性(CD4+/CD8+)、自然杀伤(NK)细胞均明显高于对照组,CD8+明显低于对照组(P<0.05)。透析后30 d,观察组的体质量指数(BMI)及白蛋白(ALB)、前白蛋白(PA)水平高于对照组(P<0.05)。透析后30 d,观察组的白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)以及C反应蛋白(CRP)水平低于对照组,白细胞介素-10(IL-10)水平高于对照组(P<0.05)。透析后30 d,观察组的24 h尿蛋白定量以及胱抑素C(CysC)、血肌酐(Scr)、血尿素氮(BUN)、视黄醇结合蛋白(RBP)水平低于对照组,差异具有统计学意义(P<0.05)。结论个体化饮食护理有助于提升MHD患者的营养状态,增强免疫功能,降低透析所致的炎症反应,值得推广。

Objective To explore the effect of individualized diet nursing on immune function in patients with maintenance hemodialysis(MHD).Methods A total of 80 uremic patients who underwent MHD in our hospital from January 2016 to December 2020 were selected and divided into control group(routine nursing)and observation group(routine nursing+individualized diet nursing)according to the parity of admission number,with 40 cases in each group.The nursing effects of the two groups were compared.Results At 30 d after dialysis,the cluster of differentiation 4 positive(CD4^(+)),CD4^(+)CD25^(+),cluster of differentiation 4 positive/cluster of differentiation 8 positive(CD4^(+)/CD8^(+))and natural killer(NK)cell in the observation group were significantly higher than those in the control group,and CD8^(+)was significantly lower than that in the control group(P<0.05).At 30 d after dialysis,the body mass index(BMI)and albumin(ALB),prealbumin(PA)levels in the observation group were higher than those in the control group(P<0.05).At 30 d after dialysis,the levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)in the observation group were lower than those in the control group,and the level of interleukin-10(IL-10)was higher than that in the control group(P<0.05).At 30 d after dialysis,the 24 h urinary protein quantification and the levels of cystatin C(CysC),serum creatinine(Scr),blood urea nitrogen(BUN)and retinol binding protein(RBP)in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion Individualized diet nursing is helpful to improve the nutritional status of patients with MHD,enhance immune function,and reduce the inflammatory response caused by dialysis,it is worth promoting.