早期肠内营养在老年维持性血液透析患者骨质疏松中的应用效果  

Clinical application of early enteral nutrition in the treatment of osteoporosis in elderly patients undergoing maintenance hemodialysis

作　　者：王妮 陈君[1] 蔡晓云 林之斌[2] 文惠 Wang Ni;Chen Jun;Cai Xiaoyun;Lin Zhibin;Wen Hui(Department of Critical Medicine,Haikou People's Hospital,Haikou 570208,China;Department of Orthopaedics,Haikou People's Hospital,Haikou 570208,China)

机构地区：[1]海口市人民医院重症医学科,海口570208 [2]海口市人民医院骨科,海口570208

出　　处：《中国医学前沿杂志（电子版）》2021年第11期97-101,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的探究早期肠内营养对维持性血液透析(maintenance hemodialysis,MHD)的老年患者骨质疏松的影响。方法选取2017年4月至2020年2月于海口市人民医院进行MHD的老年患者120例为研究对象,根据治疗方案的不同将其分为对照组和研究组,每组各60例。对照组患者接受正常饮食干预,研究组患者在正常饮食干预的基础上口服肠内营养混悬液。比较两组患者治疗前后蛋白质指标[血红蛋白(hemoglobin,Hb)、转铁蛋白(transferrin,TF)、白蛋白(albumin,Alb)、前白蛋白(prealbumin,PA)]、骨代谢标志物[Ⅰ型前胶原氨基端前肽(N-terminal propeptide of typeⅠprocollagen,PINP)、Ⅰ型胶原C末端肽(C-terminal telopeptide of typeⅠcollagen,CTX)、骨钙蛋白(osteocalcin,BGP)、降钙素(calcitonin,CT)]、营养素、能量、三大营养物质供能比及骨密度的差异。结果治疗后6个月,两组患者血清Hb、TF、Alb、PA、PINP、BGP水平,钙、磷、维生素A、维生素D、总能量摄入量,蛋白质、碳水化合物供能比,腰椎和左侧股骨颈的骨密度均显著高于本组治疗前(均P<0.05),血清CTX、CT水平均显著低于本组治疗前(均P<0.05);研究组患者血清Hb、TF、Alb、PA、PINP、BGP水平,钙、磷、维生素A、维生素D、总能量摄入量,蛋白质、碳水化合物供能比,腰椎和左侧股骨颈的骨密度均显著高于对照组(均P<0.05),血清CTX、CT水平均显著低于对照组(均P<0.05)。研究组患者脆性骨折发生率显著低于对照组(χ^(2)=7.434,P=0.006)。结论早期肠内营养可有效促进行MHD的老年患者营养素的合理摄入,优化患者营养状况,增加骨密度,减少脆性骨折的发生。Objective To explore the effect of early enteral nutrition on osteoporosis in elderly patients undergoing maintenance hemodialysis(MHD).Method A total of 120 elderly patients who underwent MHD in Haikou People’s Hospital from April 2017 to February 2020 were selected as the research objects,and they were divided into control group and study group according to different treatment plans,with 60 cases in each group.Patients in control group received normal diet intervention,and patients in study group received oral enteral nutrition suspension on the basis of normal diet intervention.The protein indexes[hemoglobin(Hb),transferrin(TF),albumin(Alb),prealbumin(PA)],bone metabolism markers[N-terminal propeptide of typeⅠprocollagen(PINP),C-terminal telopeptide of typeⅠcollagen(CTX),osteocalcin(BGP),calcitonin(CT)],nutrients,energy,the energy supply ratio of the three major nutrients,and bone density were compared between the two groups before and after treatment.Result Six months after treatment,serum Hb,TF,Alb,PA,PINP,BGP levels,calcium,phosphorus,vitamin A,vitamin D,total energy intake,protein,carbohydrate energy supply ratio,and bone density of lumbar spine and left femoral neck of the two groups were significantly higher than those before treatment in this group(all P<0.05),and the serum CTX and CT levels were significantly lower than those before treatment in this group(all P<0.05).The serum Hb,TF,Alb,PA,PINP,BGP levels,calcium,phosphorus,vitamin A,vitamin D,total energy intake,protein,carbohydrate energy supply ratio,and bone density of lumbar spine and left femoral neck in study group were significantly higher than those in control group(all P<0.05),serum CTX and CT levels were significantly lower than those of control group(all P<0.05).The incidence of fragility fractures in study group was significantly lower than that in control group(χ^(2)=7.434,P=0.006).Conclusion Early enteral nutrition can effectively promote the reasonable intake of nutrients in elderly patients undergoing MHD,optimize nutritional s

关 键 词：早期肠内营养 维持性血液透析 慢性肾衰竭 老年患者 骨质疏松 

分 类 号：R580[医药卫生—内分泌] R459.3[医药卫生—内科学]