维持性血液透析患者透析中进食标准化管理方案的构建与效果评价  

Construction and effect of the standardized intradialytic meal management program for maintenance hemodialysis patients

作　　者：陶珍晖[1,2] 朱丹[2] 井路路[3] 叶虹[4] 张莹莹[4] 吴瑛[1] TAO Zhenhui;ZHU Dan;JING Lulu;YE Hong;ZHANG Yingying;WU Ying(School of Nursing,Capital Medical University,Beijing,100069,China;不详)

机构地区：[1]首都医科大学护理学院,北京市100069 [2]北京大学第一医院护理部 [3]北京大学第一医院临床营养科 [4]北京大学第一医院肾内科血液透析中心

出　　处：《中国护理管理》2023年第8期1142-1147,共6页Chinese Nursing Management

基　　金：北京大学第一医院科研种子基金课题(2019SF22)。

摘　　要：目的:构建维持性血液透析患者透析中进食标准化管理方案并分析其应用效果,以促进该临床实践的标准化和科学化。方法:通过文献检索、预实验构建透析中标准化进食管理方案。选取2021年9月至2022年3月北京3家三级医院既往透析过程中不进食的患者为研究对象,干预组接受12周透析中标准化进食管理方案,对照组继续保持不进食;采用招募率和保留率评价方案的可行性;比较两组患者透析中不良事件发生率、尿素清除指数(Kt/V)、血清白蛋白水平、营养不良炎症评分(Malnutrition Inflammation Score,MIS)。结果:共纳入78例患者,干预组40例、对照组38例。方案的招募率为89.7%,干预组和对照组的保留率分别为85.0%、81.6%。干预组透析中低血糖症状发生率低于对照组(P<0.001);透析中不良事件和Kt/V<1.2的发生率组间差异均无统计学意义(P>0.05);两组患者血清白蛋白水平差异无统计学意义(P>0.05);在基线血清白蛋白水平<40g/L的亚组中,干预组MIS<5分者的占比明显高于对照组(P<0.05)。结论:本研究构建的透析中进食标准化管理方案具有较高的可行性,透析中进食的相关风险可控并有效减少了血液透析患者低血糖症状的发生,对存在低蛋白血症的血液透析患者营养状态的改善具有较好效果。Objective:To construct a standardized intradialytic meal management program for maintenance hemodialysis patients and evaluate its effects,to make eating during dialysis a standard and scientific practice of care.Methods:Based on literature search,and pilot-study,the standardized intradialytic meal management program was established.From September 2021 to March 2022,patients in three tertiary hospitals in Beijing who didn't eat during dialysis were enrolled.The intervention group received the 12-week standardized intradialytic meal management program,while the control group remained not eating during dialysis.The feasibility of the program was evaluated with enrollment and retention rates.The incidence of adverse events during dialysis,urea clearance index(Kt/V),serum albumin and the Malnutrition-Inflammation score(MIS)were compared between the two groups.Results:A total of 78 patients were randomized to the intervention group(n=40)and control group(n=38).The enrollment rate of the program was 89.7%;the retention rates of the intervention group and the control group were 85.0%and 81.6%,respectively.Differences of adverse events during dialysis and the incidence of Kt/V<1.2 were not statistically significant between the two groups(P>0.05).The incidence of hypoglycemia in the intervention group was lower than that in the control group(P<0.001).There were no significant differences in serum albumin level between the two groups(P>0.05).Among the subgroups with a baseline albumin level less than 40 g/L,the incidence of MIS<5 was significantly higher in the intervention group than that in the control group(P<0.05).Conclusion:The standardized intradialytic meal management program is feasible to control eating-related risks during dialysis,reduce the occurrence of hypoglycemia,and improve the nutritional status of patients with hypoalbuminemia.

关 键 词：维持性血液透析 透析中进食 蛋白质能量消耗 症状性低血压 低血糖 

分 类 号：R473[医药卫生—护理学] R197[医药卫生—临床医学]