營養衛教對血液透析患者高血磷的影響

Effects of nutrition and health education on hyperphosphatemia in hemodialysis patients

目的觀察營養衛教對高血磷的血液透析(hemodialysis,HD)患者飲食行為以及血磷水平的影響。方法選取經充分HD治療以及口服降磷藥物治療3個月後平均血磷值仍大於1.78mmol/L的患者,隨機分為研究組和對照組,營養師分别於第2和第4個月對研究組患者實施2次一對一個别式高磷血症飲食指導。分析比較衛教前後的知識、態度、行為問卷分數、血磷水平和血磷達標率。結果40例患者資料完整並完成研究,平均年齡64.6±12.1歲,平均每人每週外出用餐6次;75%的患者經常飲用咖啡、奶茶或茶。經衛教干預,研究組患者對加工食品是高磷食物的認知比例由66.7%顯著提升至90.5%(P<0.05);干預後對低磷飲食的知識(P=0.014)評分較干預前明顯提高,行為評分亦見有提高,但未達統計學差異。研究組患者干預後血磷值有下降趨勢,血磷達標率有上升趨勢,但未達統計學差異。結論營養衛教對改善患者對高磷食物的認知以及低磷飲食的知識和行為有一定幫助,但未能改善血磷水平。

Objective To observe the effects of individualized low phosphorus diet nutrition education by dietitians on the dietary behavior and serum phosphorus levels of patients with hyperphosphatemia on hemodialysis(HD).Methods Patients with average serum phosphorus levels greater than 1.78mmol/L after 3 months of adequate HD and oral phosphate lowering drug treatment were selected and randomly divided into a study group and a control group.Dietitians provided two sessions of one-by-one hyperphosphatemia dietary nutrition education to the study group patients at the 2nd and 4th months,respectively.The knowledge,attitude,and behavior questionnaire(KAP)scores,serum phosphorus levels,and serum phosphorus compliance rate were analyzed and compared before and after nutrition health education.Results Forty participants completed the study,with an average age of 64.6±12.1 years old and their averagedining out per person was six times per week;75%of the participants frequently drank coffee,milk tea or tea.After low phosphorus diet education intervention,the proportion of participants in the study group who recognized processed foods as high phosphorus foods significantly increased from 66.7%to 90.5%(P<0.05).After diet education intervention,the knowledge of low phosphorus diet(P=0.014)and behaviorscores were significantly improved compared to before intervention.However,there was no statistically significant difference.After diet education intervention,the serum phosphorus levels of the study group participants showed a downward trend,whereas the serum phosphorus compliance rate showed an upward trend,but there was no statistically significant difference.Conclusion Nutritional education is effectivein improving patients'understanding of high phosphorus foods and their attitudes towards low phosphorus diets,but it has not been able to show improvements in theirserum phosphorus levels.