个体化的综合营养支持对维持性血液透析患者的应用效果分析

Effect of individualized comprehensive nutritional support on maintenance hemodialysis patients

目的分析个体化的综合营养支持对维持性血液透析(maintenance hemodialysis,MHD)患者的应用效果。方法选择江苏省人民医院2019年3月—2022年3月收治的110例M H D患者,运用简单随机法分为研究组、对照组,各55例。2组均接受常规管理,研究组加用个体化综合营养支持。对比2组干预前、干预3个月后肾脏病饮食依从态度量表(Renal Adherence Altitudes Renal Questionnaire,RAAQ)、肾脏病饮食依从行为量表(Renal Adherence Behavior Questionnaire,RABQ)评分,营养指标血清白蛋白(albumin,ALB)、血清前白蛋白(prealbumin,PA)、血清转铁蛋白(transferrin,TRF)和患者提供的主观营养状况评估量表(Patient-generated Subjective Nuitrition Assessment,PG-SGA)、营养不良炎症评分(malnutrition inflammation,MIS)以及三头肌皮褶厚度(triceps skinfold thickness,TSF)、上臂肌围(armmuscle circum ference,AMC)及肌酐(creatinine,C r)变化。结果干预3个月后,2组RAAQ、RABQ评分均较干预前升高(t=8.51~13.35,P均<0.001),研究组的评分均高于对照组,差异有统计学意义(t=5.03、3.84,P均<0.001);2组ALB、PA、TRF均较干预前升高(t=2.05~5.93,P<0.05或<0.001),研究组均高于对照组,差异有统计学意义(t=2.39、2.09、2.97,P=0.019、0.039、0.004);2组PG-SGA、MIS评分均较干预前下降(t=6.29~17.67,P均<0.001),研究组评分均低于对照组,差异有统计学意义(t=7.56、6.22,P均<0.001);2组TSF、AMC、Cr均较干预前升高(t=3.82~7.78,P<0.05或<0.001),研究组均高于对照组,差异有统计学意义(t=2.69、3.36、2.01,P=0.008、0.001、0.047)。结论个体化的综合营养支持有助于改善MHD患者饮食及行为依从性,对于提高患者营养状态、体质及肾功能也有积极作用。

Objective To analyze the applicability of individualized comprehensive nutritional support among maintenance hemodialysis(MHD)patients.Methods A total of 110 MHD patients admitted to Jiangsu Provincial People's Hospital from March 2019 to March 2022 were selected for the study.Using a simple random method,they were divided into the study group(n=55)and the control group(n=55).Both groups received routine treatment,but the study group additionally received individualized comprehensive nutritional support.The Renal Adherence Altitudes Renal Questionnaire(RAAQ)and Renal Adherence Behavior Questionnaire(RABQ)scores,as well as nutritional indicators including serum albumin(ALB),prealbumin(PA),transferrin(TRF),patient-generated subjective nutrition assessment(PG-SGA),malnutrition inflammation score(MIS),triceps skinfold thickness(TSF),arm muscle circumference(AMC),and creatinine(Cr)before and after interventions were compared.Results After 3-month interventions,RAAQ and RABQ scores in both groups increased(t=8.51-13.35,all P<0.001),especially in the control group,and the difference was of statistical significance(t=5.03,3.84,P<0.001 for both).Levels of ALB,PA,and TRF in both groups increased after interventions(t=2.05-5.93,P<0.05 or<0.001),particularly in the study group,and the difference was statistically significant(t=2.39,2.09,2.97,P=0.019,0.039,0.004).PG-SGA and MIS scores in both groups decreased after interventions(t=6.29-17.67,all P<0.001),especially in the study group,with statistically significant difference(t=7.56,6.22,P<0.001 for both).TSF,AMC,and Cr levels in both groups increased after interventions(t=3.82-7.78,P<0.05 or<0.001),particularly in the study group,and the difference was also of statistical significance(t=2.69,3.36,2.01,P=0.008,0.001,0.047).Conclusion Individualized comprehensive nutritional support helps improve the diet and behavioral compliance of MHD patients,having a positive effect on the nutritional status,physique,and renal function of patients.