早期营养管理在腹膜透析患者中的应用  

Application of early nutrition management in peritoneal dialysis patients

作　　者：刘芳[1] 蒋一倩 邵伟娟 王珂 臧秀娟[2] LIU Fang;JIANG Yiqian;SHAO Weijuan;WANG Ke;ZANG Xiujuan(Department of Nutrition,Shanghai Songjiang District Central Hospital,Shanghai 201600,China;Department of Nephrology,Shanghai Songjiang District Central Hospital,Shanghai 201600,China)

机构地区：[1]上海市松江区中心医院营养科,上海201600 [2]上海市松江区中心医院肾内科,上海201600

出　　处：《右江医学》2023年第11期984-990,共7页Chinese Youjiang Medical Journal

基　　金：上海市松江区科学技术攻关项目(2017sjkjgg53)。

摘　　要：目的探讨入院24 h内早期营养管理对腹膜透析患者营养状况的影响。方法2020年3月至12月收治的31例腹膜透析患者为对照组,按腹膜透析管理流程实施常规护理,由腹膜透析护士负责治疗、营养管理、延续护理等;2021年3月至12月收治的32例患者为干预组,建立营养支持小组实施早期营养管理。测量上臂中段肌肉周径(MAMC)、营养不良-炎症评分(MIS)、血生化指标[包括血清白蛋白(Alb)、血红蛋白(Hb)、尿素氮(BUN)、肌酐(Scr)、血钙(Ca)和血磷(P)],分析干预前后的变化。结果随访后,干预组失访2例,对照组失访1例。干预组干预后MIS评分较干预前显著下降(P<0.001)。干预后,干预组MIS评分显著低于对照组(P<0.001)。干预组Alb较干预前提高了2.95 g/L(P<0.001),Hb提高了16.33 g/L(P<0.001)。干预组肾功能指标BUN较干预前下降了4.64 mmol/L(P<0.001),Scr较干预前下降了117.08μmol/L(P<0.001)。干预组干预后血清P低于干预前(P<0.001),血清Ca高于干预前(P<0.001)。干预后干预组腹膜炎发生率低于对照组(P=0.032)。结论早期营养管理可以改善患者营养状况、肾功能和血生化指标。Objective To explore the effect of early nutritional management within 24 hours of admission on the nutritional status of peritoneal dialysis patients.Methods 31 peritoneal dialysis patients admitted to hospital from March to December 2020 were selected as control group,and routine care was implemented on them according to peritoneal dialysis management process.Peritoneal dialysis nurses were responsible for treatment,nutrition management,and continuing care,etc.32 patients admitted to hospital from March to December 2021 were included in intervention group,and a nutrition support group was established to implement early nutrition management.And then,mid-arm muscle circumference(MAMC),malnutrition-inflammation score(MIS)as well as blood biomarkers including serum albumin(Alb),hemoglobin(Hb),blood urea nitrogen(BUN),creatinine(Scr),blood calcium(Ca)and blood phosphorus(P)were measured and compared before and after intervention in the two groups.Results After follow-up,2 cases were lost in the intervention group and 1 case was lost in the control group.After intervention,the MIS score of the intervention group significantly decreased compared to that before intervention(P<0.001),and the MIS score of the intervention group was significantly lower than that of the control group(P<0.001).In the intervention group,Alb increased by 2.95 g/L(P<0.001)and Hb increased by 16.33 g/L(P<0.001)compared to those before intervention.In the intervention group,renal function index BUN decreased by 4.64 mmol/L(P<0.001),and Scr decreased by 117.08μmol/L(P<0.001)compared to those before intervention.After intervention,the serum P in the intervention group was lower than that before intervention(P<0.001),the serum Ca was higher than that before intervention(P<0.001),and the incidence of peritonitis in the intervention group was lower than that in the control group(P=0.032).Conclusion Early nutritional management can improve the nutritional status,renal function,and blood biochemical indicators of patients.

关 键 词：早期营养管理 腹膜透析 营养不良 营养支持小组 

分 类 号：R459.5[医药卫生—治疗学] R473[医药卫生—临床医学]