基于营养风险筛查的个性化营养方案在肾移植患者中的应用  

Application of personalized nutritional program based on nutrition risk screening in patients undergoing kidney transplantation

作　　者：覃莉枝 石泽亚[1] 方春华[2] 聂曼华[2] 谭亮[2] 刘萍[2] 刘静[2] Qin Lizhi;Shi Zeya;Fang Chunhua;Nie Manhua;Tan Liang;Liu Ping;Liu Jing(Department of Nursing,the First Affiliated Hospital of Hunan Normal University(Hunan Provincial People's Hospital),Changsha 410005,China;Department of Kidney Transplantation,the Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]湖南师范大学附属第一医院(湖南省人民医院)护理教研室,长沙410005 [2]中南大学湘雅二医院肾脏移植科,长沙410011

出　　处：《中华现代护理杂志》2022年第11期1508-1514,共7页Chinese Journal of Modern Nursing

基　　金：湖南省自然科学基金面上项目(湖南创新型省份建设专项)(2019JJ40428)。

摘　　要：目的评价基于营养风险筛查的个性化营养方案在肾移植患者中的应用效果。方法采用便利抽样法,选取于2020年11月—2021年5月在中南大学湘雅二医院完成肾移植手术的90例患者作为研究对象,采用信封进行抽签,将其随机分为对照组(45例)和试验组(45例)。对照组给予常规基础治疗和护理,试验组在对照组的基础上给予营养风险筛查的个性化营养方案。观察两组患者术前及术后第3、7、14天的总蛋白、白蛋白、前白蛋白、视黄醇结合蛋白、血清铁、总铁结合力、血红蛋白等营养指标的变化,比较两组患者肾功能指标的变化(如血肌酐水平、内生肌酐清除率、肾小球滤过率),比较两组患者出院3个月内的再入院发生率。结果试验组干预第3、7、14天的视黄醇结合蛋白水平均优于对照组,而血肌酐水平、肾小球滤过率低于对照组,差异均有统计学意义(P<0.05)。干预第14天,试验组的总蛋白、血红蛋白、总铁结合力、血清铁的水平均高于对照组,内生肌酐清除率低于对照组,差异有统计学意义(P<0.05)。重复测量方差分析结果显示,时间对于两组患者营养及肾功能指标的恢复均有影响(P<0.05);两组患者的总蛋白、血红蛋白、视黄醇结合蛋白、血肌酐水平及肾小球滤过率干预的主效应差异有统计学意义(P<0.05),且血红蛋白、视黄醇结合蛋白、血清铁的水平干预因素和时间存在交互作用(P<0.05)。随访3个月,试验组患者再入院率为0,对照组为13.6%(6/44),差异有统计学意义(P<0.05)。结论营养风险筛查联合个性化营养方案可有效提高肾移植患者的机体营养状况,促进移植肾功能恢复,降低再入院率,改善患者临床结局。Objective To evaluate the application effect of a personalized nutritional program based on nutrition risk screening in kidney transplant patients.Methods Using the convenient sampling method,a total of 90 patients who completed kidney transplantation in the Second Xiangya Hospital of Central South University from November 2020 to May 2021 were selected as the research objects.Envelopes were used to draw lots,and patients were randomly divided into the control group(45 cases)and the test group(45 cases).The control group was given routine basic treatment and nursing care,while the test group was given a personalized nutrition plan based on nutritional risk screening at basis of the control group.The changes of nutritional indexes such as total protein,albumin,prealbumin,retinol-binding protein,serum iron,total iron-binding capacity,and hemoglobin were observed before operation and on the 3rd,7th,and 14th days after operation in the two groups.The changes of renal function indicators(such as serum creatinine level,endogenous creatinine clearance rate,glomerular filtration rate)were compared between the two groups,and the incidence of readmission within 3 months of discharge was compared between the two groups.Results The levels of retinol-binding protein in the experimental group on the 3rd,7th,and 14th days of intervention were better than those in the control group,while the serum creatinine level and glomerular filtration rate were lower than those in the control group,and the differences were statistically significant(P<0.05).On the 14th day of intervention,the levels of total protein,hemoglobin,total iron binding capacity and serum iron in the test group were higher than those in the control group,and the clearance rate of endogenous creatinine was lower than that in the control group,and the differences were statistically significant(P<0.05).Repeated measures analysis of variance showed that time had an effect on the recovery of nutritional and renal function indexes of patients in both groups(P<0.05).There

关 键 词：肾移植 营养筛查 营养不良 个性化营养支持 临床结局 

分 类 号：R699.2[医药卫生—泌尿科学] R459.3[医药卫生—外科学]