基于倾向评分匹配分析药学营养门诊服务模式对腹膜透析患者营养状况的影响  

Analysis of the influence of pharmacy nutrition outpatient service modes on dialysis patients’nutrition status based on propensity score matching

作　　者：杨香瑜[1] 李璐璐[1] 丁艳琼[2] 罗庆[2] 万胜[2] 张韶辉[1] YANG Xiangyu;LI Lulu;DING Yanqiong;LUO Qing;WAN Sheng;ZHANG Shaohui(Department of Pharmacy,2.Department of Nephrology,Wuhan No.1 Hospital,Hubei Wuhan 430022,China)

机构地区：[1]武汉市第一医院药学部,湖北武汉430022 [2]武汉市第一医院肾病内科,湖北武汉430022

出　　处：《中国医院药学杂志》2024年第5期570-575,共6页Chinese Journal of Hospital Pharmacy

基　　金：湖北省卫生健康科研基金项目(编号:WJ2021M005)。

摘　　要：目的:探讨药学营养门诊服务模式对腹膜透析患者营养状况的影响。方法:武汉市第一医院腹膜透析药学营养门诊由肾病内科专科临床药师、肠外肠内营养专科临床药师共同坐诊,依托武汉市腹膜透析质控中心信息化平台,建立药学营养信息版块,进行药学评估和营养评估。开发出肾病营养微信小程序,结合特色指导,实现门诊高效服务。本研究采用回顾性队列研究方法,选择2022年1月至2022年12月在该院规律接受腹膜透析的门诊患者为研究对象。将患者按照是否就诊药学营养门诊分为药学营养门诊组和普通门诊组。采用倾向性评分匹配方法,按1∶1比例匹配,卡钳值设置为0.03。分别统计2组患者匹配后基线资料,对2组患者半年内各项指标均值进行评价。同时采用logistic回归分析腹膜透析患者白蛋白水平达标的影响因素。结果:药学营养门诊组患者血清白蛋白、总蛋白、血红蛋白水平均高于普通门诊组,SGA评分低于普通门诊组。标准化蛋白分解代谢率高于普通门诊组。C-反应蛋白水平低于普通门诊组。多因素回归分析显示,就诊药学营养门诊、总蛋白水平≥60 g·L^(-1)是患者白蛋白达标的保护因素,透析龄≥60月是白蛋白达标的危险因素。结论:该院腹膜透析药学营养门诊有助于腹膜透析患者白蛋白水平达标,改善腹膜透析患者营养状况。该服务模式充分体现了药师在门诊慢病患者营养管理中的价值,值得推广应用。OBJECTIVE To explore the influence of pharmacy nutrition outpatient service modes on dialysis patients’nutrition status.METHODS The pharmacy nutrition clinic was jointly attended by clinical pharmacists specializing in nephrology and clinical pharmacists specializing in parenteral enteral nutrition.Relying on the information platform of the peritoneal dialysis quality control center of our city,the pharmaceutical nutrition information section was established to conduct pharmaceutical assessment and nutrition assessment.The kidney disease nutrition WeChat mini program was developed,and combined with characteristic guidance,efficient outpatient service was achieved.In this retrospective cohort study,outpatients who regularly received peritoneal dialysis in our hospital from January 2022 to December 2022 were enrolled as the study objects.The patients were divided into pharmaceutical nutrition outpatient group and general outpatient group according to whether they visited pharmacy nutrition outpatient department or not.At the same time,propensity score matching was adopted in the ratio of 1∶1,and the caliper value was set to 0.03.The baseline characteristics of the two groups of patients after being matched were analyzed,and the mean value of each index in the two groups was calculated and compared for evaluation.Logistic regression was used to analyze the influencing factors of albumin standard in peritoneal dialysis patients.RESULTS Serum albumin level,total protein level and hemoglobin level were higher while SGA score was lower in pharmacy nutrition outpatient group than that of the general outpatient group.The standardized protein catabolic rate was also higher in pharmacy nutrition outpatient group.In the contrary,the C-reactive protein level was lower in pharmacy nutrition outpatient group than that in the general clinic group.Multivariate Logistic regression analysis showed that visits to the pharmacy nutrition clinic and total protein level≥60 g·L^(-1)were the protective factors while dialysis age≥

关 键 词：药学门诊 腹膜透析 倾向评分匹配 

分 类 号：R969.3[医药卫生—药理学]