承德地区维持性血液透析患者营养不良状况及干预措施探讨

目的 营养不良直接影响患者的生活质量,故对维持性血液透析(maintenance hemodialysis,MHD)患者的营养状况进行分析,探讨合理有效的干预措施.方法 对210例患者及健康对照组进行营养学评估,采用膳食分析,测定肱三头肌皮褶厚度、上臂围、上臂肌围(MAMC)等人体测量学指标和血清白蛋白(ALB)、前白蛋白、血肌酐、血红蛋白等实验室指标,对可能影响患者营养状况的常见因素进行分析.结果 210例患者营养不良发生率高达83.8％(176/210),其中重度营养不良占26.7％(56/210).所有患者普遍存在着蛋白质及能量摄入不足,血红蛋白、血浆白蛋白普遍低.蛋白质摄入量平均仅为(0.76±0.32)g·kg-1·d-1,热量摄入量平均仅为(94.39±32.13)kJ·kg-1·d-1.农村合作医疗患者营养状况较城镇职工医保患者更差,且营养素摄入量更少,蛋白质摄入量为(0.79±0.08)g·kg-1·d-1 vs (0.89±0.09)g·kg 1·d-1；热量摄入量(91.55±15.65)kJ·kg-1·d-1vs (101.46±13.89)kJ·kg-1·d-1,差异有统计学意义(P＜0.05).营养不良状况发生率高主要与蛋白质及能量摄入不足、透析不充分、促红细胞生成素应用量不足、经济文化落后等因素有关.结论 在承德地区MHD患者营养不良的发生率高.重视MHD患者的营养不良情况,加强营养支持与管理,充分透析以及社会支持是改善营养不良的主要措施.

Analysis of factors causing malnutrition and study solutions in patients with maintenance hemodialysis in area of Chengde

Objective Nutritional state affects directly the quality of life of patients with maintenance hemodialysis（MHD）,thus it is necessary to analyze the nutritional state of MHD patients,and find out effective solutions to improve the nutritional state.Methods Totally 210 MHD patients were enrolled in this study.The nutritional state of the patients as subject group and healthy persons as control group were evaluated.Meal analysis was used to assess the nutritional status,meanwhile the body measurement target,including triceps skin-fold thickness（TSF）,mid-upper arm circumference（MAC）,mid-upper arm muscle circumference（MAMC）,and biochemical parameters including serum prealbumin,serum albumin,serum creatinine,haemoglobin were measured.Analysis was conducted on the possible factors causing malnutrition.Results The incidence of malnutrition was 83.8%（176/210） in 210 cases of MHD,severe malnutrition accounted for 26.7%（56/210）.Defective intake of protein and calory existed generally in all patients,meanwhile the haemoglobin and serum albumin were low.The mean intake of protein was（0.76±0.32） g·kg^-1·d^-1,and the mean intake of calory merely（94.39±32.13） kJ·kg^-1·d^-1.The nutritional state of countryside cooperative medical care patients was poor than that the patients with town medical insurance.The mean intake of protein was（0.79±0.08） g·kg^-1·d^-1 vs（0.89±0.09） g·kg^-1·d^-1,and the mean intake of calory（91.55±15.65） g·kg^-1·d^-1 vs（101.46±13.89） kJ·kg^-1·d^-1.The difference showed statistic significance（P〈0.05）.Malnutrition concerned with some factors below：defective intake of protein and calory,insufficient dialysis,low dose of erythropoiesis stimulating,hysteresis economy and culture.Conclusion Incidence of malnutrition is high in MHD patients in Chengde area.The solutions include：paying high attention to malnutrition,strengthening nutrition administration,sufficient dialysis,and society support.