充分的控磷饮食宣教与维持性血液透析患者磷管理效果的关系  

Association of adequate dietary phosphate restriction education and phosphorus management in maintenance hemodialysis patients

作　　者：庞娇阳 张炜晨 黄碧红[1] 曹艳佩 张家瑛[1] 余晨[3] 叶志斌[4] 陈靖[1] 王梦婧[1] Pang Jiaoyang;Zhang Weichen;Huang Bihong;Cao Yanpei;Zhang Jiaying;Yu Chen;Ye Zhibin;Chen Jing;Wang Mengjing(Division of Nephrology,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Nursing,Huashan Hospital,Fudan University,Shanghai 200040,China;Division of Nephrology,Tongji Hospital,Tongji University,Shanghai 200065,China;Division of Nephrology,Huadong Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院肾脏科,上海200040 [2]复旦大学附属华山医院护理部,上海200040 [3]同济大学附属同济医院肾脏科,上海200065 [4]复旦大学附属华东医院肾脏科,上海200040

出　　处：《中华肾脏病杂志》2022年第4期296-303,共8页Chinese Journal of Nephrology

基　　金：国家重点研发计划(2020YFC2005003);上海申康医院发展中心市级医院新兴前沿技术联合攻关项目(SHDC12018111);促进市级医院临床技能和临床创新能力三年行动计划临床研究青年项目(SHDC2020CR4014);上海市医学领军人才培养(2019LJ03);复旦大学附属华山医院科研启动基金(2019QD028);上海老年疾病人工智能辅助医疗工程技术研究中心(19DZ2251700)。

摘　　要：目的探索充分的控磷饮食宣教对维持性血液透析(maintenance hemodialysis,MHD)患者血磷水平、饮食磷摄入以及高磷血症认识的影响。方法本研究为回顾性队列研究,选取2019年10月至2020年12月于华山医院、华东医院、同济医院接受个体化降磷临床试验的MHD患者116例为研究对象,根据研究过程中是否接受充分的控磷饮食宣教将其分为短时组(84例)与长时组(32例),短时组不接受控磷饮食宣教或接受控磷饮食宣教时间≤60 min,长时组接受控磷饮食宣教且宣教时间>60 min;比较两组经4周干预后血磷水平、饮食磷摄入情况、患者对高磷血症的认识水平。结果基线时,短时组和长时组间年龄[64(56,69)岁比65(60,73)岁,Z=-1.493,P=0.136]、男性比例[58.3%(49/84)比56.3%(18/32),χ^(2)=0.041,P=0.839]、透析龄[55(26,130)个月比53(20,132)个月,Z=-0.062,P=0.951]以及体重指数、糖尿病史、单室尿素清除指数(spKt/V)、使用骨化三醇比例、血钙、血磷、全段甲状旁腺素和饮食中蛋白、磷、磷蛋白比的差异均无统计学意义(均P>0.05);充分的控磷饮食宣教减少了饮食磷摄入[777.98(653.81,943.16)mg/d比896.56(801.51,1015.51)mg/d,Z=-2.903,P=0.004],降低了饮食磷蛋白比[13.16(11.52,14.21)mg/g比15.27(13.31,17.48)mg/g,Z=-3.929,P<0.001]及血磷水平[(1.42±0.37)mmol/L比(1.85±0.44)mmol/L,t=4.984,P<0.001],显著提高了MHD患者的血磷达标(62.5%比41.7%,χ^(2)=4.034,P=0.045)以及对高磷血症原因(完全正确加部分正确所占百分比:93.8%比72.6%,χ^(2)=6.120,P=0.013)、高磷血症后果(完全正确加部分正确所占百分比:78.1%比52.4%,χ^(2)=6.372,P=0.012)、高磷食物种类(完全正确加部分正确所占百分比:65.6%比52.4%,χ^(2)=1.650,P=0.199)的认识水平。结论对MHD患者进行充分的控磷饮食宣教,可显著提高患者对高磷血症的认识水平,降低患者血磷水平及饮食磷摄入。Objective To explore the effects of dietary phosphate restriction education on serum phosphorus level,dietary phosphate intake and the knowledge of hyperphosphatemia in maintenance hemodialysis(MHD)patients.Methods This study was a retrospective cohort study.A total of 116 hemodialysis patients in Huashan Hospital,Huadong Hospital and Tongji Hospital from October 2019 to December 2020 were enrolled in this study.They were divided into short-term group(84 cases)and long-term group(32 cases).The short-term group did not receive education or received education≤60 minutes.Meanwhile,the long-term group received education>60 minutes.Serum phosphorus level,dietary phosphate intake and knowledge of hyperphosphatemia were compared between the two groups after 4 weeks.Results At baseline,age[64(56,69)years old vs 65(60,73)years old,Z=-1.493,P=0.136],the proportion of males[58.3%(49/84)vs 56.3%(18/32),χ^(2)=0.041,P=0.839],dialysis age[55(26,130)months vs 53(20,132)months,Z=-0.062,P=0.951],body mass index,diabetes history,single-pool Kt/V,proportion of calctriol used,blood calcium,blood phosphorus,intact parathyroid hormone and dietary protein,dietary phosphorus and dietary phosphorus protein ratio had no statistical significance between short-term group and long-term group(all P>0.05).Adequate dietary phosphate restriction education reduced dietary phosphate intake[777.98(653.81,943.16)mg/d vs 896.56(801.51,1015.51)mg/d,Z=-2.903,P=0.004],phosphate/protein ratio[13.16(11.52,14.21)mg/g vs 15.27(13.31,17.48)mg/g,Z=-3.929,P<0.001]and serum phosphorus level[(1.42±0.37)mmol/L vs(1.85±0.44)mmol/L,t=4.984,P<0.001].Meanwhile,such education significantly improved achievement rate of serum phosphorus(62.5%vs 41.7%,χ^(2)=4.034,P=0.045).In addition,patients in long-term group answered more questions correctly(completely correct plus partially correct)about the causes(93.8%vs 72.6%,χ^(2)=6.120,P=0.013),poor prognosis(78.1%vs 52.4%,χ^(2)=6.372,P=0.012)of hyperphosphatemia as well as the types of food with high phosphate(65.6%vs 52

关 键 词：肾透析 磷 膳食 食品和营养 高磷血症 病人教育 控磷饮食宣教 宣教时间 

分 类 号：R692.5[医药卫生—泌尿科学]