持续不卧床腹膜透析患者的营养评估分析  

The nutritional assessment on patients with continuous ambulatory peritoneal dialysis

作　　者：王艳[1] 陈孟华[1] 

机构地区：[1]宁夏医学院附属医院,宁夏银川750004

出　　处：《宁夏医学杂志》2008年第5期420-422,共3页Ningxia Medical Journal

基　　金：宁夏科技攻关项目(2001-022-03)

摘　　要：目的调查持续不卧床腹膜透析(CAPD)患者的营养状况并分析其相关影响因素。方法①调查了78例CAPD治疗患者的一般情况及原发病因;②采用MDRD方程计算肌酐清除率,以评估患者的残余肾功能;③以主观综合性营养评估(SGA)、握力试验等指标评估病人营养状况;④用Charlson指数评估患者合并症情况;⑤采用ECOG和Karnofsky活动指数评分评估患者的活动能力。结果①依据SGA评分,CAPD患者营养不良总发生率为51.3%;与营养良好组相比,营养不良组患者的Hb、A lb、右侧肱三头肌皮褶厚度、髂皮褶厚度降低,CRP明显升高(P(0.05);与营养良好组相比,虽然营养不良组患者的CCr、透析液总剂量、液体总清除量没有明显的差异,但透析液糖浓度、透析龄、腹腔液体的超滤量明显高于营养良好组,而尿量明显减少(P(0.05);④与营养良好组相比,营养不良组患者的Charlson合并症指数、水肿发生率明显增高,活动能力明显减低,(P(0.05)。结论CAPD患者营养不良的发生率高,残肾功能、炎症反应、贫血、合并症情况、容量负荷状态等诸多因素均可影响CAPD患者的营养状态。Objective To assess nutritional status of continuous ambulatory peritoneal dialysis （CAPD） patients. Methods Seventy - eight patients were included in the present study. The patients＇ nutritional status evaluated by SGA, hand grip test, serum albumin and so on. Patient＇ s residual renal function was assessed by MDRD formula and the comorbidities were evaluated by Charlson Index. Index of ECOG and Karnofsky Index were used to assess patient＇ s physical activity. Results There were 40 patients （51.3% ） were malnourished. Compared with nourished patients,the hemoglobin（Hb） , albumin（Alb）, triceps brachii -skinfold thickness and ilio - skinfold thickness were significantly lower and the CRP was significantly higher in malnourished patients （P 〈 0. 05 ）. There were no significant differences in the residual renal function, dialysate doses, and total fluid removal between the nourished and malnourished patients. Whereas the dialysate glucose load, dialysis period and peritoneal uhrafiltration were significantly higher and urine volume was lower in malnourished patients（ P 〈 0. 05 ）. Furthermore, there were significantly higher Charlson Index, lower physical activity capability and more edematous patients in malnourished patients（ P 〈 0.05 ）. Conclusion The incidence of malnutrition is significantly high in CAPD patients, which is influenced by many factors such as inflammation, anemia, complication status, residual renal function, fluid status and so on.

关 键 词：营养不良 持续不卧床腹膜透析 主观综合性营养评估法 

分 类 号：R692.5[医药卫生—泌尿科学]