营养干预及个体化护理对终末期肾病腹膜透析患者营养风险、营养不良及生存质量影响的随机对照研究  

Effects of nutritional intervention and individualized nursing on nutritional risk, undernutrition, and quality of life in end-stage renal disease patients with peritoneal dialysis： a randomized controlled study

作　　者：周晓容[1] 于康[2] 唐琴琴[1] 

机构地区：[1]江西省抚州市第一人民医院（南昌大学第五附属医院）营养科,344000 [2]中国医学科学院北京协和医学院北京协和医院临床营养科,100730

出　　处：《中华临床营养杂志》2011年第4期222-226,共5页Chinese Journal of Clinical Nutrition

摘　　要：目的研究营养干预和个体化护理对终末期肾病（ESRD）腹膜透析患者营养风险、营养不良和生存质量的影响。方法按随机表将符合研究方案要求的104例ESRD腹膜透析患者随机分为对照组和研究组，完成本研究并进入最后统计分析的共102例（对照组50例、研究组52例）。在常规治疗基础上，对照组患者自行进食，接受常规护理；研究组患者接受6个月的营养干预和个体化护理。分别于干预前、后对两组患者进行营养风险筛查、人体测量和生存质量评价。结果两组研究对象的基线资料具有可比性。干预后，研究组营养风险和营养不良（营养不足）发生率均显著低于对照组（营养风险：32.6%比56.0%，P=0.028；营养不足：15.4%比34.0%，P=0.038）。干预后两组人体测量学指标均较干预前下降，研究组握力降低的差值显著小于对照组［（-1.6±0.9）kg比（-9.9±1.4）kg，P=0.001］，而两组三头肌皮褶厚度、上臂围和上臂肌围降低差值的差异无统计学意义（P均＞0.05）。干预后研究组生存质量评分较干预前增高，对照组的生存质量评分下降，两组干预前后肾脏疾病及透析相关生存质量项目评分的差值［（2.5±4.4）分比（-7.9±7.4）分，P=0.001］和一般健康相关生存质量评分的差值［（3.4±4.1）分比（-6.8±6.3）分，P=0.001］的差异有统计学意义。结论营养干预和个体化护理可能有助于改善ESRD腹膜透析患者的营养状况和生存质量。ObjectiveTo explore the effects of nutritional intervention and individualized nursing on nutritional risk, undernutrition and quality of life （QOL） in end-stage renal disease （ESRD） patients with peritoneal dialysis. MethodsA total of 104 ESRD patients with peritoneal dialysis who met the inclusion criteria of the protocol were enrolled and randomized to receive nutritional intervention plus individualized nursing （study group, n=52 analyzed） or self-diet plus routine nursing （control group, n=50 analyzed） for 6 months. Nutritional risk, anthropometry, and QOL of the two groups were analyzed pre- and post-nutritional intervention. ResultsBaseline data were comparable in the two groups. Prevalences of nutritional risk and undernutrition in study group were significant lower than those in control group after the intervention （nutritional risk： 32.6% vs. 56.0%, P=0.028;undernutrition： 15.4% vs. 34.0%, P=0.038）. The decrease of grip strength in study group between pre- and post-study was significantly less than that in control group [（-1.6±0.9） kg vs. （-9.9±1.4） kg, P=0.001], but there were no significant differences in other parameters related to anthropometry, including triceps skin-fold thickness,upper arm circumference, and arm muscle circumference （all P〉0.05）. The QOL score significantly increased in study group after intervention but decreased in control group. The differences of renal disease and dialysis-related scores （ΔKDTA：2.5±4.4 vs. -7.9±7.4,P=0.001） and general condition scores （ΔSF-36：3.4±4.1 vs. -6.8±6.3,P=0.001） before and after intervention were significantly different between two groups. ConclusionNutrition intervention and individualized nursing may help to improve the nutritional status and QOL in ESRD patients with peritoneal dialysis.

关 键 词：终末期肾病 腹膜透析 营养干预 护理 生存质量 

分 类 号：R473.5[医药卫生—护理学]