应用红细胞生成素改善血液透析患者的营养状况

目的　了解红细胞生成素（EPO）对血液透析患者营养状况的影响。方法对25例血透患者在应用红细胞生成素前，治疗后3月、6月分别进行营养状况的评价，包括膳食摄入分析、人体学、生化指标和血浆氨基酸谱的测定。结果红细胞生成素治疗后的蛋白质、能量摄入以及各营养指标均较治疗前增加，其中以治疗6月后的蛋白质、能量摄入和三头肌皮褶厚度（TSF）、转铁蛋白（TF）、纤维连接蛋白（FN）的增加更为显著。血浆氨基酸中，亮氨酸、缬氨酸和丝氨酸在治疗后有增加，精氨酸、鸟氨酸和甘氨酸则有下降，尤以6月后的变化更为显著。结论红细胞生成素在纠正血透患者贫血的同时可改善其营养状况。     

维持血透病人的营养状况分析

目的：了解血液患者的营养状况并找出引起其营养不良的相关因素。方法：采用ＳＧＡ法对１０６例血透患者进行营养学评价，本学测量及生化检查作为营养指标进行各相关因素分析。结果：１０６例血透患者中６１．０％存在在不同程度的营养不良，普通存在能量、蛋白质摄入不足、饮食结构不合理，与健康人比较各营养学指标均偏低（Ｐ〈０．０５），摄入充分组、透析充分组、透析充分组及酸中毒较轻组各营养学指标均较对照组有显著性差异（     

慢性血透患者营养状况的调查及其影响因素

慢性血透患者营养状况的调查及其影响因素田军路建饶陆石张金元我们通过对人体学测量及部分生化指标的测定，对３５例维持性血透患者的营养状况及其影响因素进行评价，旨在延长血透患者生存期和提高生活质量。材料与方法维持性血透患者３５例，男１９例，女１６例，平均年...     

维持性血液透析患者的精准饮食管理

目的 探讨精准饮食管理对血液透析患者营养状况及液体摄入依从性的影响。方法 将慢性肾衰竭血液透析患者120例按照透析单双日分为对照组和研究组各60例,对照组给予常规饮食指导,研究组采取精准饮食管理,包括精准测量、精准评估、精准记录与精准纠偏。比较两组干预前与干预6个月后液体摄入依从性及营养指标。结果 干预6个月后,研究组液体摄入依从性显著高于对照组,白蛋白、血红蛋白值显著高于对照组(P<0.05,P<0.01)。结论 精准饮食管理有利于改善血液透析患者营养状况,提高其液体摄入依从性。     

维持性血液透析患者血清脂联素与营养状况的关系

目的探讨维持性血液透析患者血清脂联素与营养状况的关系。方法对81例维持性血液透析患者应用改良定量主观全面营养评估（MQSGA）法、血生化指标、人体指数学指标综合评估其营养状况,同时采用ELISA法测定血清脂联素水平,评估血清脂联素与营养状况之间的相关性。结果维持性血液透析患者营养不良患病率为69．1％。血清脂联素平均为（8．66±2．62）μg／ml,与MQSOA、肱三头肌皮褶厚度、上臂肌围、腰臀比、体重指数等营养指标成线性相关关系。结论维持性血液透析患者大多存在不同程度的营养不良,血清脂联素水平与营养指标相关,可作为评估血液透析患者营养不良的指标之一。     

维持性血液透析患者血常规检测分析

目的：观察维持性血液透析患者血常规指标变化及其影响因素。方法：对４６例血液透析患者行血常规、血生化及透析充分性指标等检测，并对可能影响血常规的常见因素进行分析。结果：血液透析患者白细胞和血小板正常，而红细胞减少；促红细胞生成素对红细胞及红细胞压积有影响。结论：纠正有关因素有助于改善血液透析患者贫血。     

三种方法对血液透析患者营养评估及影响因素比较分析

目的:对维持性血液透析(MHD)患者进行蛋白质能量消耗(PEW)评估并分析比较,为临床诊疗提供依据。方法:横断面及回顾性研究。运用透析营养客观评分(OSND)、改良定量主观整体评估法(MQSGA)、人体成分分析(BCM)结合问卷调查、人体测量、生化指标对MHD患者进行营养评估及行相关性分析、自身影响因素分析。结果:348例MHD患者OSND、MQSGA、BCM评估营养不良发生率分别为79. 3%、67. 2%、42. 2%,男、女患者多项营养指标差异存在统计学意义(P 0. 05);三种方法相关性显著的营养指标及自身影响因素各有异同,MAC是共同的影响因子,评估PEW及炎症效能由高到低分别是OSND、MQSGA、BCM。结论:MHD患者普遍存在PEW,男、女性患者营养存在差异; OSND是评估PEW的敏感工具,OSND、MQSGA联合BCM,能更全面评估MHD患者营养状况,为临床工作提供准确的依据。     

维持性血液透析病人营养不良的原因分析及其护理对策

对 95例透析时间 >3个月的维持性血液透析 (MHD)病人的营养状况通过人体学测量、主观综合营养评估、实验室检查等进行评价 ,对其营养不良原因进行分析。结果 95例中发生营养不良 6 1例 (6 4 .2 % ) ;病人体重指数、上臂肌围、三头肌皮肤皱褶厚度、血浆白蛋白、前白蛋白、血红蛋白及主观综合营养评估低于正常值者达 36 .8%～81.1%。发生营养不良的原因依次为蛋白质及能量摄入不足、透析不充分、透析膜的生物相容性差、透析液微生物学质量较差、心理因素、慢性炎症状态及未应用促红细胞生成素 (EPO)等。提示MHD病人营养状况较差 ,医护人员应采取针对性措施改善其营养状况 ,提高其生活质量。     

MHD患者心脏瓣膜钙化与营养状况的相关性分析

目的:分析维持性血液透析(maintenance hemodialysis,MHD)患者心脏瓣膜钙化(cardiac valve calcification,CVC)与营养状况的相关性。方法:选取2019年10月—2020年10月在我院行血液透析且资料完整的MHD患者110例,收集患者的一般临床资料、生化结果,并测量人体学指标,使用MQSGA评分量表评估患者的营养状况,通过多普勒超声心动图评估心脏瓣膜钙化的情况,根据有无瓣膜钙化分为两组,钙化组45例,非钙化组65例,比较两组间临床资料的差异,分析营养状况评分及其他营养相关指标与心脏瓣膜钙化的关系。结果:与非钙化组相比,钙化组MQSGA评分、年龄、透析龄、碱性磷酸酶、血清钙、超敏C反应蛋白水平均显著增高,上臂围、肱三头肌皮褶厚度、血清白蛋白、前白蛋白均显著降低,差异均具有统计学意义(P0.05);Spearman相关性分析显示MQSGA评分(r=0.413,P0.001)与心脏瓣膜钙化呈正相关;肱三头肌皮褶厚度(r=-0.389,P0.001)、血清白蛋白(r=-0.190,P=0.047)与心脏瓣膜钙化呈负相关。logistic回归分析显示影响MHD患者心脏瓣膜钙化的危险因素包括MQSGA评分、年龄、透析龄、肱三头肌皮褶厚度、超敏C反应蛋白。结论:MHD患者心脏瓣膜钙化发生率高;营养不良是维持性血液透析患者心脏瓣膜钙化发生的危险因素。     

维持性血液透析患者营养状况与动脉钙化进展的相关性及危险因素分析

目的:分析维持性血液透析患者营养状况与动脉钙化进展的相关性及危险因素。方法:选择本院2016年07月～2017年08月进行维持性血液透析的终末期肾病患者93例作为研究对象,分别评估入组患者动脉钙化,营养状况并收集相关资料。采用Spearman相关分析对维持性血液透析患者营养状况与动脉钙化进展的相关性进行分析,并分别采用单因素方差分析、logistics回归分析对影响动脉钙化进展的危险因素进行分析。结果:动脉钙化组患者MQSGA评分高于非动脉钙化组,上臂围,上臂肌围、干体重均低于非钙化组,统计学分析结果表明差异有统计学意义(P 0. 05)。采用Spearman相关分析对动脉钙化情况与营养状况评分和MAMC值的相关性,结果如下图,营养状况评分与动脉钙化呈显著正相关(r=0. 272,P=0. 008),上臂肌围与动脉钙化呈显著负相关(r=-0. 387,P=0. 001)。多因素logistics回归分析结果表明影响维持性血液透析患者动脉钙化的危险因素包括25羟维生素D3,年龄、糖尿病、全段甲状旁腺激素、总胆固醇、磷。结论:维持性血液透析患者营养状况与动脉钙化进展呈显著正相关,影响维持性血液透析患者动脉钙化的危险因素包括25羟维生素D3,年龄、糖尿病、全段甲状旁腺激素、总胆固醇、磷。     

Anthropometry and plasma valine, amino acids, and proteins in the nutritional assessment of hemodialysis patients

Non-fasting plasma amino acids, proteins, anthropometric measurements, urea, and creatinine for 17 hemodialysis patients were compared with values in normal patients of similar age and sex. Values were characteristic for renal failure but with similarities to protein-energy malnutrition. Partial correlation coefficients, correcting for age and height, identified nutritional and non-nutritional factors. Plasma valine was the most correlated variable and was used to rank and group the patients. The group with valine less than 150 micrometers/liter had low values for 17 variables. Valine, isoleucine, leucine, threonine, asparagine, weight, and arm muscle circumference were interrelated and reflected malnutrition whereas fat correlated with calorie intake, and histidine and serine with protein intake. Taurine, aspartic acid, cystine, citrulline, urea, creatinine, prealbumin and retinol-binding protein were decreased in malnutrition but were higher than normal due to a loss of renal function. Fourteen variables, less affected by malnutrition, were changed by specific non-nutritional factors. Hemodialysis patients of long standing (1 to 11 years) apart from two patients with recurrent sepsis, were adequately nourished, but those on hemodialysis for less than 15 months, most of whom had previously received peritoneal dialysis, were malnourished. Malnutrition in dialysis patients was due to protein and energy deficiency enhanced by metabolic abnormalities of amino acids. Our study shows that plasma valine is interrelated with other nutritional variables and may be used to assess protein-energy malnutrition.     

维持性血液透析患者营养状况的评价

目的：评价维持性血液透析(MHD）患的营养状况。方法：对57例维持性血透患进行人体测量、生化指标的测定、饮食评估、主观综合营养评估(SGA)及综合性营养评估(GNA)。结果：不同指标评估营养不良的发生率分别为：三头肌皮皱厚度(TSF)66．7％，上臂中段肌肉周径(MAMC)33．3％，白蛋白(Alb)31．6％，前白蛋白(PA)45．6％，转铁蛋白(TRF)63．2％，饮食蛋白摄入(DPI)33．3％，SGA38．6％，GNA47．4％。各项指标均属正常仅占14，0％。依据GNA评分，营养不良组与营养良好组进行比较，Alb、PA、蛋白分解率(nPCR)、DPI、SGA评分均有统计学差异。结论：综合评价结果表明86．0％透析患存在不同程度的营养不良。GNA对血透患具有良好的营养评价作用。对MHD患进行常规的营养评价及合理的营养指导对预后有重要意义。     

Malnutrition after total gastrectomy

We studied food intake and nutritional status of 28 patients who had undergone total gastrectomy for gastric cancer. At discharge, patients were instructed to keep a high protein, high calorie diet and to record food intake on a specific form, twice weekly. Nutritional follow-up, consisting in a computerized determination of dietary intake and nutritional assessment was performed monthly during the first postoperative year. The average calorie intake was 1,431.8 Kcal/day one month after operation and 2,225.4 Kcal/day one year after surgery (p less than 0.001). In particular, only one patient exceeded 2,000 Kcal/day one month after total gastrectomy, while 21 patients exceed 2,00 Kcal/day one year after operation. The evaluation of nutritional parameters in the postoperative course showed that a significant increase in body weight, serum albumin and total iron binding capacity was observed only in patients who exceed 2,000 Kcal/day one year after operation. These results indicate that malnutrition is not an inevitable consequence of total gastrectomy; in fact, a close relationship between calorie intake and the variations of nutritional parameters was observed.     

透析充分性、微炎症和残存肾功能对血液透析患者营养状态的影响

目的探讨透析充分性、微炎症和残存肾功能对血液透析患者营养状态的影响。方法本院维持性血液透析患者114例入选。检测指标包括（1）整体营养状况：使用MQSGA评估表并测定血清胰岛素样生长因子（IGF）1、胰岛素样生长因子结合蛋白3（IGFBP-3）、Hb、Alb。（2）人体指数学测定。（3）血液透析充分性：测定血清iPTH、β2-MG、BUN并计算Kt／V、nPCR。（4）残存肾功能：测量患者24h尿量。（5）微炎症：测定血清CRP、IL-6、TNF-α。结果（1）Kt／V、iPTH、β2-MG分别与测量握力（HGS）、上臂中部肌肉周径（MAMC）、无骨上臂肌肉面积（AMA）、Alb、Hb、nPCR、IGF-1相结合，MQSGA呈不同程度的相关和回归关系。（2）残存尿量在血透第1年内，与HGS、肱三头肌皮褶（TSF）、MAMC、Alb、nPCR、IGF-1呈显著相关和回归关系。（3）IL-6、TNF-α、CRP分别与HGS、MAMC、AMA、Alb、TSF、Hb、nPCR、IGF-1呈不同程度的相关和回归关系。（4）影响血透患者营养状况的因素分别是Kt／V、iPTH、IL-6、TNF—α、β2-MG、残存尿量，其中Kt／V、iFFH、IL-6、TNF—α是独立影响因素。结论血液透析中小分子毒素的透析不充分，微炎症可能是患者营养不良的关键因素之一。残存肾功能可能在透析第1年内对营养状况有显著影响。在上述诸因素中。Kt／V、iPTH、IL-6、TNF-α是影响营养状态的独立因素。     

Increased dietary sodium is independently associated with greater mortality among prevalent hemodialysis patients

Dietary sodium is thought to play a major role in the pathogenesis of hypertension, hypervolemia, and mortality in hemodialysis patients; hence, sodium restriction is almost universally recommended. Since the evidence upon which to base these assumptions is limited, we undertook a post-hoc analysis of 1770 patients in the Hemodialysis Study with available dietary, clinical, and laboratory information. Within this cohort, 772 were men, 1113 black, and 786 diabetic, with a mean age of 58 years and a median dietary sodium intake of 2080 mg/day. After case-mix adjustment, linear regression modeling found that higher dietary sodium was associated with a greater ultrafiltration requirement, caloric and protein intake; sodium to calorie intake ratio was associated with a greater ultrafiltration requirement; and sodium to potassium ratio was associated with higher serum sodium. No indices were associated with the pre-dialysis systolic blood pressure. Cox regression modeling found that higher baseline dietary sodium and the ratio of sodium to calorie or potassium were each independently associated with greater all-cause mortality. No association between a prescribed dietary sodium restriction and mortality were found. Thus, higher reported dietary sodium intake is independently associated with greater mortality among prevalent hemodialysis patients. Randomized trials will be necessary to determine whether dietary sodium restriction improves survival.     

Prevention of complications in orthopedic surgery secondary to nutritional depletion

One of the major factors in the prevention of complications in orthopedic surgery patients is the maintenance of adequate nutrition. Trauma and elective surgery patients have nutritional requirements that are far greater than is generally realized. The use of nutritional assessment profiles will help to reveal patients who are malnourished or becoming malnourished, and will help to assess nutritional replacement. Protein and calorie malnutrition has a significant effect on wound healing, immunocompetence, and fracture healing. Surgeons should have the nutritional status of their patients in mind at all times and thereby avoid the complications associated with malnutrition.     

Food intake and nutritional status after total gastrectomy: results of a nutritional follow-up

We studied dietary intake and nutritional status of 23 patients for 6 months after total gastrectomy with Roux-en-Y reconstruction. At discharge, patients were instructed to keep to recommended dietary allowances (RDA) and to record food intake on a specific form twice weekly. Nutritional follow-up was performed monthly and consisted of a computerized determination of food intake and of a nutritional assessment. The average daily energy intake was 6.10 MJ (1457.9 kcal) in the first postoperative month and 8.87 MJ (2118.4 kcal) in the sixth (P less than 0.0005). In the first monthly follow-up no patient reached RDA. By the sixth month mean daily calorie intake was greater than or equal to RDA in 14 patients (group A), while 9 patients (group B) did not reach RDA. A significant increase in body weight, serum albumin, total iron binding capacity and arm muscular circumference was observed in group A, while a significant decrease in body weight and arm muscular circumference was noted in group B. Moreover, of the seven patients who showed weight loss at 6 months only one was group A. These data indicate that malnutrition is not an inevitable consequence of total gastrectomy and can be prevented by an adequate calorie intake. A close relationship between dietary intake and postoperative nutritional parameters was observed. In gastrectomized patients a strict nutritional follow-up is very important to obtain an adequate dietary intake.