夜间长时间血液透析对尿毒症患者营养状态的影响  

Influence of nocturnal prolonged hemodialysis on nutrition status in uremic patients

作　　者：孙丽君[1] 梅长林[1] 戎殳[1] 马熠熠[1] 贺靓靓[1] 胡小红[1] 徐成钢[1] 张翼翔[1] 叶朝阳[1] 赵学智[1] 

机构地区：[1]第二军医大学附属长征医院肾内科解放军肾脏病研究所,上海200003

出　　处：《中华肾脏病杂志》2012年第1期16-20,共5页Chinese Journal of Nephrology

摘　　要：目的研究夜间长时间血液透析（INHD）对尿毒症患者营养状态的影响。方法对32例维持性血液透析患者行INHD，3次／周，7．5h／次。选取同期常规透析（3次／周，4h／次）患者35例作为对照组。采用自身对照及组间对照研究方式对患者进入INHD时（0月）及开始后6个月的营养学指标（物理测量、生化指标、SGA评分、3日膳食Et记等）进行监测及评估，比较INHD对患者营养状态的影响。结果INHD与对照组的年龄、性别、体质量和原发病相匹配，差异无统计学意义。INHD组患者在6个月末时体质量（BW）、肱三头肌皮褶厚度（TSF）、握力（HGS）均有不同程度增加，但与对照组差异无统计学意义；而上臂周径（MAC）由（27．1±4．2）cm增加至（30．5~6．1）cm，差异有统计学意义（P〈0．05）；与对照组（26．9＋3．4）cm差异也有统计学意义（P〈0．05）。INHD组血白蛋白、血钙、iPTH与对照组差异无统计学意义；血磷水平比基线值下降（0．5＋0．5）txmol／L，比对照组下降（0．1±0．6）μmol／L，差异均有统计学意义（均P〈0．01）。INHD组SGA评分在6个月末时与对照组比较有显著改善（P=0．03）；膳食摄入能量、蛋白、脂肪、钙、磷、钾等均有增加，但与对照组差异无统计学意义。结论INHD能提高维持性血液透析患者的食欲和膳食摄入量，且能降低患者血磷水平，较好地改善患者营养状态．具有良好的廊用前景。Objective To observe the influence of nocturnal prolonged hemodialysis （INHD） on patients＂ nutrition status. Methods Thirty-two maintenance hemodialysis patients received INHD （3 times per week and 7.5 hours each session） and thirty-five maintenance hemodialysis patients received conventional hemodialysis （3 times per week and 4 hours each session） as control were observed for 6 months. The nutrition status of these patients on various aspects which concluded physical measurements, laboratory tests, and dietary record at baseline （0 month） and exit （6 months） were recorded. Results （1）There were no differences in age,sex, body weight,and primary diseases between two groups. （2）The body weight, triceps skinfold thickness （TSF）, and hand grip strength increased at exit point, but no statistical difference compared with the control group. Mid-upper arm circumference （MAC） increased signicantly from （27.1±4.2） to （30.5±6.1） cm （P〈0.05）. Compared with the control group （26.9±3.4） cm, there was a significant difference （P〈0.05）. （3）Serum phosphate decreased significantly from （0.5±0.5） to （0.1±0.6） μmol/L （P=0.001） in INHD group. （4）The nutrition status were improved in INHD group evaluated by subjective global assessment （SGA）（P=0.03）. （5） Dietary intake was recorded by a 3-day food record. Dietary intake of energy, protein, lipid, calcium, potassium, and phosphate increased in INHD group. None of the differences achieved statistical significance between two groups. Conclusion As compared with conventional hemodialysis, INHD can increase the dietary intake, decrease serum phosphate level, and improve patients nutrition status.

关 键 词：血液透析 尿毒症 营养状态 

分 类 号：R692.5[医药卫生—泌尿科学]