不同基本医疗保障维持性血液透析患者营养不良的发生及干预

目的观察不同基本医疗保障下维持性血液透析(MHD)患者营养不良发生情况及干预效果。方法维持性血液透析患者150例,按医保支付比例不同将患者分为3组:城保组84例,镇保组22例和农保组44例。采用主观综合营养评估法对营养不良发生率进行评定;比较不同医保组的血清白蛋白、前白蛋白、转铁蛋白、血红蛋白、尿素氮、肌酐、尿素清除指数(Kt/V)等人体测量学指标,并给予提高透析充分性、饮食指导、纠正贫血等药物支持一系列综合干预。结果城保组的营养不良发生率为21%,镇保组的营养不良发生率为46%,农保组的营养不良发生率为52%,农保组和镇保组的营养不良发生率较城保组明显提高(P均<0.05),而农保组和镇保组比较差异无统计学意义(P>0.05)。城保组的人体测量学指标中血清白蛋白、前白蛋白、转铁蛋白、血红蛋白均较镇保组和农保组高(P均<0.05),而镇保组和农保组比较无显著性差异。经过综合干预,3组患者轻度营养不良32例(21%),中度营养不良13例(9%),重度级营养不良8例(4%),与治疗前比较有显著性差异(P均<0.01)。结论不同基本医疗保障对MHD患者的营养不良发生率有一定的影响,通过提高透析充分性、改善营养等综合措施能够改善透析患者的营养不良。

Occurrence and intervention of malnutrition in patients for maintenance hemodialysis under different basic medical care

Objective It is to observe the incidence of malnutrition in patients for maintenance hemodialysis under different basic medical insurance and the effect of intervention.Methods According to the different proportion paid in medicare,150 patients were divided into three different groups: city insurance group(84 cases),town insurance group(22 cases) and farmer’s insurance group(44 cases).The incidence of malnutrition was assessed by subjective method of assessing;the markers of anthropometric indexes,serum albumin,prealbumin,transferrin,hemoglobin,blood urea nitrogen,creatinine,Kt/V were detected to compare.And the comprehensive range of intervention was given as improve dialysis adequacy,dietary guidance,correct anemia drugs.Results The rate of malnutrition was 21% in city insurance group,46% in town insurance group and 52% in farmer’s insurance group,there were significant differences between city insurance compared with others(P<0.01),there was no significant difference between the farmer’s insurance group and the town insurance group(P>0.05).In city insurance group,the levels of anthropometric indexes,serum albumin,prealbumin,transferring and hemoglobin were higher than those in the town or farmer’s insurance group(P<0.05),while there was no significant difference between the town insurance group and the farmer’s insurance group.After comprehensive intervention,patients with mild malnutrition were 32(21%),moderate malnutrition were 13(9%) and moderate to severe level of malnutrition was 8(4%),by Wilcoxon rank sum test(P<0.01),there was significant difference compared with before treatment.Conclusion There are certain impacts in the rate of malnutrition in maintenance hemodialysis patients with different types of health insurance.The malnutrition can be improved in dialysis patients by comprehensive measures such as improve dialysis adequacy and dietary guidance.