高原地区尿毒症患者通过综合治疗改善营养状况的研究
|
摘要
目的观察高原地区尿毒症患者的营养状况,并分析通过综合治疗后的改善情况。方法采取回顾性研究,选取2017年3月至2018年3月拉萨市人民医院血液透析中心收治的维持性血液透析患者35例,平均年龄43. 9岁,男性占51. 4%,尿素氮下降率达标患者占91. 4%。综合治疗参照国内相关指南,嘱患者优质蛋白饮食,保证热量及维生素摄入,必要时辅以α酮酸制剂,同时保证患者充分的透析治疗。记录患者的基本资料及营养相关临床指标,比较进入透析时和规律透析3个月后的主观综合性营养评估结果及营养生化指标。结果开始进入透析治疗时,患者的血清白蛋白为(33. 30±4. 71) g/L,总胆固醇为(3. 38±0. 75) mmol/L,血肌酐水平为(797. 64±250. 11)μmol/L。规律透析治疗3个月后,患者的血白蛋白为(36. 33±3. 67) g/L,总胆固醇为(3. 78±0. 63) mmol/L,血肌酐水平为(882. 26±260. 17)μmol/L。主观综合性营养评估结果显示,营养不良患病率由82. 9%下降至68. 6%,上述差异均有统计学意义(P <0. 05)。而甘油三酯的变化无统计学差异(P> 0. 05)。结论高原地区尿毒症患者的营养不良情况更为严重,通过透析及综合治疗,营养状况可以得到显著改善。高原地区需要更加重视营养不良这一尿毒症并发症。
Objective To observe the nutritional status of uremic patients in plateau area and to analyze the improvement after comprehensive treatment. Methods The clinical data of 35 patients treated in the hemodialysis center,Lhasa People's Hospital Tibet Autonomous Region with maintenance hemodialysis during March 2017 to March 2018 were retrospectivey analyzed. The average age of these patients was 43. 9 years old,male patients accounted for 51. 4%,and the urea reduction ratio standard in patients accounted for 91. 4%. Comprehensive treatment refers to domestic related guidelines,given patients a high quality protein diet to ensure calorie and vitamin intake,supplemented with alpha ketoacid preparations when necessary,and ensure adequate dialysis treatment for these patients. and records of basic data and nutrition related clinical indicators were recorded. Nutritional biochemical indexes and results of subjective comprehensive nutritional evaluation were compared at the beginning of dialysis and in 3 months after regular dialysis. Results At the beginning of dialysis treatment,the average level of serum albumin was( 33. 30± 4. 71) g/L,total cholesterol was( 3. 38 ± 0. 75) mmol/L and serum creatinine before dialysis was( 797. 64 ± 250. 11) μmol/L,respectively.After regular dialysis treatment for 3 months,serum level of albumin increased to( 36. 33 ± 3. 67) g/L,total cholesterol increased to( 3. 78 ±0. 63) mmol/L,and serum creatinine before dialysis increased to( 882. 26 ± 260. 17) μmol/L. Results of subjective global assessment showed that the prevalence of malnutrition decreased from 82. 9% to 68. 6%. The above results were statistically different. Conclusion The malnutrition of patients with uremia in plateau area was more serious. The nutritional status of these patients can be significantly improved after dialysis and comprehensive treatment. hence it needs to pay more attention to malnutrition and complication of uremia in plateau area.
Objective To observe the nutritional status of uremic patients in plateau area and to analyze the improvement after comprehensive treatment. Methods The clinical data of 35 patients treated in the hemodialysis center,Lhasa People's Hospital Tibet Autonomous Region with maintenance hemodialysis during March 2017 to March 2018 were retrospectivey analyzed. The average age of these patients was 43. 9 years old,male patients accounted for 51. 4%,and the urea reduction ratio standard in patients accounted for 91. 4%. Comprehensive treatment refers to domestic related guidelines,given patients a high quality protein diet to ensure calorie and vitamin intake,supplemented with alpha ketoacid preparations when necessary,and ensure adequate dialysis treatment for these patients. and records of basic data and nutrition related clinical indicators were recorded. Nutritional biochemical indexes and results of subjective comprehensive nutritional evaluation were compared at the beginning of dialysis and in 3 months after regular dialysis. Results At the beginning of dialysis treatment,the average level of serum albumin was( 33. 30± 4. 71) g/L,total cholesterol was( 3. 38 ± 0. 75) mmol/L and serum creatinine before dialysis was( 797. 64 ± 250. 11) μmol/L,respectively.After regular dialysis treatment for 3 months,serum level of albumin increased to( 36. 33 ± 3. 67) g/L,total cholesterol increased to( 3. 78 ±0. 63) mmol/L,and serum creatinine before dialysis increased to( 882. 26 ± 260. 17) μmol/L. Results of subjective global assessment showed that the prevalence of malnutrition decreased from 82. 9% to 68. 6%. The above results were statistically different. Conclusion The malnutrition of patients with uremia in plateau area was more serious. The nutritional status of these patients can be significantly improved after dialysis and comprehensive treatment. hence it needs to pay more attention to malnutrition and complication of uremia in plateau area.
引文
[1]Q酮酸制剂在肾内科应用专家协作组.慢性肾脏病蛋白营养治疗共识[J].中华肾脏病杂志,2005,21(7):421-424.
[2]中国医师协会肾脏病医师分会血液透析充分性协作组.中国血液透析充分性临床实践指南[J].中华医学杂志,2015,95(34):2748-2753.
[3]Westland GJ,Grootendorst DC,Halbesma N,et al.The nutritional status of patients starting specialized predialysis care[J].J Ren Nutr,2015,25(3):265-270.
[4]Gutiérrez OM.Contextual poverty,nutrition,and chronic kidney disease[J].Adv Chronic Kidney Dis,2015,22(1):31-38.
[5]杨子艳,郝晶,程博,等.维持性血液透析患者营养状况分析[J].中国临床保健杂志,2009,12(6):564-566.
[6]杨勤兵,张凌,李平,等.应用主观全面评定法评价维持性血液透析患者营养状况[J].中国临床营养杂志,2008,16(3):143-146.
[7]李颖.高原环境下的人群营养[J].中国保健营养(中旬刊),2013,8:92-93.
[8]刘玲玉,刘阳阳,鲁路,等.素食饮食对慢性透析患者营养状态和心血管风险的影响[J].广东医学,2017,38(4):559-562.
[9]Pedrini LA,De Cristofaro V,Comelli M,et al.Long-term effects of high-efficiency on-line haemodiafiltration on uraemic toxicity.A multicentre prospective randomized study[J].Nephrol Dial Transplant,2011,26(8):2617-2624.
[2]中国医师协会肾脏病医师分会血液透析充分性协作组.中国血液透析充分性临床实践指南[J].中华医学杂志,2015,95(34):2748-2753.
[3]Westland GJ,Grootendorst DC,Halbesma N,et al.The nutritional status of patients starting specialized predialysis care[J].J Ren Nutr,2015,25(3):265-270.
[4]Gutiérrez OM.Contextual poverty,nutrition,and chronic kidney disease[J].Adv Chronic Kidney Dis,2015,22(1):31-38.
[5]杨子艳,郝晶,程博,等.维持性血液透析患者营养状况分析[J].中国临床保健杂志,2009,12(6):564-566.
[6]杨勤兵,张凌,李平,等.应用主观全面评定法评价维持性血液透析患者营养状况[J].中国临床营养杂志,2008,16(3):143-146.
[7]李颖.高原环境下的人群营养[J].中国保健营养(中旬刊),2013,8:92-93.
[8]刘玲玉,刘阳阳,鲁路,等.素食饮食对慢性透析患者营养状态和心血管风险的影响[J].广东医学,2017,38(4):559-562.
[9]Pedrini LA,De Cristofaro V,Comelli M,et al.Long-term effects of high-efficiency on-line haemodiafiltration on uraemic toxicity.A multicentre prospective randomized study[J].Nephrol Dial Transplant,2011,26(8):2617-2624.