改良主观全面营养评价法在维持性血液透析患者营养评价中的应用与护理对策

目的探讨改良主观全面营养评价法(subjective global assessment,SGA)在维持性血液透析(maintenance hemodialysis,MHD)患者营养评价中的应用效果,并提出护理对策。方法便利抽样法选择2010年2月至2013年2月在华中科技大学附属同济医院住院行透析治疗的患者80例,分别应用改良SGA、传统SGA对其进行营养评估,同时进行人体学指标、实验室指标的测定,通过对改良SGA评分、传统SGA评分与患者一般情况、人体学指标、实验室指标的相关性分析,比较两者的评价效果。结果改良SGA评分结果定量的评分系统(dialysis malnutrition score,MS)值与年龄、三头肌皮褶厚度(triceps skinfold thickness,TSF)、上臂围(mid-upper arm circumference,MAC)、上臂肌围(mid-arm muscle circumference,MAMC)、体质量指数(body mass index,BMI)、白蛋白(albumin,ALB)、谷草转氨酶(aspartate aminotransferase,AST)、球蛋白(immunoglobulin,GLB)、肌酐(creatinine,SCr)具有相关性(P0.05或P0.01);传统SGA评分仅与TSF、MAC、BMI有相关性。结论改良SGA较传统SGA对于MHD患者营养状况的评估更敏感、有效,护理人员应根据营养评价相关结果而采取一定综合性措施,从而全面有效地对患者进行营养管理,以预防并发症,降低病死率,提高患者生活质量。

Application and Nursing Countermeasure of Modified SGA in Maintenance Hemodialysis Patients Nutritional Assessment

Objective To discuss the application effects of modified SGA in maintenance hemodialysis pa-tients in the nutritional assessment proposed nursing countermeasure.Methods By convenience sampling, 80 MHD patients were selected and treated with modified SGA method,the traditional method for nutri-tional assessment respectively.Anthropometric indicators and laboratory parameters were used simultane-ously.Through the modified SGA score,traditional SGA score and general condition of patients,anthropo-metric indexes ,correlation analysis laboratory parameters to compare the effectiveness.Results Modified MS SGA score showed a significant correlation with TSF,MAC,MAMC,BMI,ALB,AST,GLB,SCr（P 〈0.05 or P 〈0.01）.Traditional SGA only correlated with TSF,MAC,BMI.Conclusion The modified method compare with the traditional method for assessment of nutritional status in MHD patients are more sensi-tive and effective.Based on the nutritional evaluation results to take comprehensive measures to effective implement nutritional management of patients for the prevention of complications,reduce mortality and improve quality of life.