饮食干预对高龄维持性血液透析患者营养状况的影响

Effect of diet intervention on nutritional status of elderly patients on maintenance hemodialysis

目的探讨饮食干预对高龄维持性血液透析患者营养状况的影响。方法将2011年1月至2014年12月在汕头大学医学院第一附属医院接受维持性血液透析的患者92例作为研究对象,按照随机数字表的方式分为观察组(n=46)和对照组(n=46)。对照组未接受系统的饮食指导,观察组接受为期6个月的系统饮食指导。6个月后分别对两组患者的营养指标进行评估和比较。结果首次透析治疗后两组维持性血液透析患者营养指标水平比较差异均无统计学意义(P>0.05);透析治疗6个月后,观察组的改良主观营养评分为(12.01±3.25)分、营养不良-炎症评分为(6.07±3.55)分,均分别低于对照组的评分(14.10±3.68)分和(8.21±4.02)分,差异均有统计学意义(P<0.05);透析治疗6个月后,观察组的体质量指数为(22.69±3.76)kg/m2、肌酐为(992.73±174.35)μmol/L、血红蛋白为(104.65±20.56)g/L、白蛋白为(41.85±5.63)g/L,均分别高于对照组的(20.32±3.21)kg/m2、(828.53±93.52)μmol/L、(92.71±17.51)g/L和(36.43±5.02)g/L,差异均有统计学意义(P<0.05);透析6个月后与首次透析时相比较,对照组患者仅肌酐发生了一定的变化(P<0.05),而观察组患者的改良主观营养评分、营养不良-炎症评分、肌酐、血红蛋白、白蛋白等均发生了显著变化,差异均有统计学意义(P<0.05)。结论饮食干预能够有效维持性血液透析患者的营养状况,并促进患者康复。

Objective To explore the effect of diet intervention on nutritional status of elderly patients on maintenance hemodialysis. Methods Ninety-two elderly patients on maintenance hemodialysis in our hospital from January2011 to December 2014 were selected and randomly divided into the observation group(n=46) and the control group(n=46). The control group did not receive systematic dietary guidance, and the observation group received a six-month diet guidance. Results After first hemodialysis, nutritional index level showed no statistically significant difference between the two groups(P>0.05). Six months after hemodialysis, the improved subjective nutritional score, malnutrition-inflammation score in the observation group were(12.01 ± 3.25) and(6.07 ± 3.55), which were significantly lower than those in the control group of(14.10±3.68) and(8.21± 4.02), P<0.05. Six months after hemodialysis, the body mass index, creatinine, hemoglobin, albumin in the observation group were(22.69 ± 3.76) kg/m2,(992.73 ± 174.35) μ mol/L,(104.65±20.56) g/L,(41.85±5.63) g/L, respectively, which were significantly higher than those in the control group of(20.32±3.21) kg/m2,(828.53±93.52) μmol/L,(92.71±17.51) g/L,(36.43±5.02) g/L, P<0.05. Comparing 6 months after hemodialysis with first hemodialysis, only creatinine in the control group changed significantly(P<0.05), while improved subjective nutritional score, malnutrition-inflammation score, creatinine, hemoglobin, albumin in the observation group all changed significantly(P<0.05). Conclusion Diet intervention can effectively improve the nutritional status of patients on maintenance hemodialysis, and promote recovery of patients.