持续性非卧床腹膜透析病人不同营养评估方法的比较及透析前后营养状况变化  

Comparison of different nutritional assessment methods for patients undergoing continuous ambulatory peritoneal dialysis and changes of nutrition before and after dialysis

作　　者：李季芳[1] 殷琪[1] 黎艺[1] 曾敏[1] LI Jifang;YIN Qi;LI Yi;ZENG Min(Hainan General Hospital,Hainan 570311 China)

机构地区：[1]海南省人民医院

出　　处：《护理研究》2019年第15期2609-2614,共6页Chinese Nursing Research

摘　　要：[目的]比较血清清蛋白、改良SGA法(MQSGA)、营养不良炎性评分(MIS)和营养风险筛查2002(NRS2002)评分4种营养评估方法对持续性非卧床腹膜透析病人营养不良的评定结果,并观察腹膜透析对尿毒症病人营养状况的影响。[方法]采用血清清蛋白、MQSGA、MIS和NRS2002对70例持续性非卧床腹膜透析的尿毒症病人营养不良进行评定,将4种评估方法与人体测量指标、血液生化指标进行相关性分析,并比较腹膜透析前和腹膜透析后6个月、12个月、24个月的血清总蛋白、磷、血红蛋白等各项临床指标。[结果]4种营养评估方法对腹膜透析病人诊断营养不良的发生率由低到高分别为:NRS2002(28.6%),血清清蛋白(57.1%),MQSGA(82.8%),MIS(100.0%)。NRS2002、MQSGA、MIS3种营养评分之间均呈相关性(P<0.05)。腹膜透析治疗后总蛋白、血红蛋白水平较治疗前显著升高(P<0.05);腹膜透析治疗后尿素氮和血磷较治疗前显著降低(P<0.05)。腹膜透析前及透析后6个月、12个月、24个月低蛋白血症发生率分别为70.0%、42.4%、45.5%、27.6%(P<0.05)。腹膜透析前及透析后第6个月、12个月、24个月高磷血症发生率分别为90.0%、37.5%、42.4%、69.0%(P<0.05)。腹膜透析前及透析后6个月、12个月、24个月贫血患病率分别为100.0%、63.6%、72.7%、69.0%(P<0.05)。[结论]MIS评分诊断腹膜透析病人营养不良的发生率最高,与其他营养评价指标的相关性更好。Objective:To compare the nutritional assessment results of malnutrition in continuous ambulatous peritoneal dialysis(CAPD)patients with serum albumin,Modified Quantitative Subjective Global Assessmen(MQSGA),Malnutrition-Inflammation Score(MIS)and Nutritional Risk Screening 2002(NRS2002),and to observe the effects of peritoneal dialysis on the nutritional status of uremic patients.Method:Malnutrition was assessed by serum albumin,MQSGA,MIS and NRS2002 in 70 patients undergoing CAPD.Correlation analysis were conducted between the four evaluation methods and human measurement indexes,blood biochemical indexes,and the clinical indexes such as total protein,phosphorus and hemoglobin.They were compared before and after peritoneal dialysis at 6 months,12 months and 24 months.Results:The incidences of malnutrition diagnosed by four nutritional assessment methods in CAPD patients were from low to high:NRS2002(28.6%),serum albumin(57.1%),MQSGA(82.8%),MIS(100.0%).The three nutritional scoring methods of NRS2002,MQSGA and MIS were all correlated(P<0.05).The total protein and hemoglobin levels after peritoneal dialysis were significantly higher than those before peritoneal dialysis(P<0.05).Blood urea nitrogen and phosphorus were significantly lower after peritoneal dialysis than before(P<0.05).The incidence of hypoproteinemia was 70.0%,42.4%,45.5%and 27.6%before and after peritoneal dialysis at 6 months,12 months and 24 months respectively(P<0.05).The incidence of hyperphosphatemia was 90.0%,37.5%,42.4%and 69.0%before peritoneal dialysis and at 6 months,12 months and 24 months after peritoneal dialysis,respectively(P<0.05).The prevalence of anemia at 6 months,12 months and 24 months after peritoneal dialysis was 100.0%,63.6%,72.7%and 69.0%respectively(P<0.05).Conclusion:The incidence of malnutrition in CAPD patients diagnosed by MIS score was the highest,and it had a better correlation with other nutritional evaluation indexes.

关 键 词：腹膜透析 低蛋白血症 营养不良 血清清蛋白 评估 相关 影响因素 

分 类 号：R47[医药卫生—护理学]