个性化饮食干预对维持性血液透析患者钙磷代谢及营养状况的影响Word文档格式.docx
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所在学院
年月日广州
硕士研究生:
谭伟
指导教师:
刘俊
摘要
血液透析(hemodialysis,HD)是目前急慢性肾功能衰竭患者主要治疗手段之一,对于延长患者生存周期及提高临床治疗效果具有重要应用价值及现实意义。
然而,当前国内外医学界诸多研究成果证实,长期采取血液透析治疗的患者由于肾功能及身体机能的下降,导致其营养摄取能力受到极其严重的影响,由此产生的钙磷代谢紊乱、生存质量较低、预后不良、死亡率居高不下已经成为当前临床中不可回避的问题之一。
如何采取有效的治疗措施来改善血液透析患者营养不良状态,促使紊乱的钙磷代谢恢复正常已经成为当前国内外医学界研究的重要课题。
虽然有越来越多的调节钙磷代谢及降低甲状旁腺激素的药物在国内面市,且疗效显著,但昂贵的价格严重影响了此类药物的广泛临床应用。
随着个性化饮食干预的兴起,我国医学界专家学者纷纷对其投入较多关注,并展开将其应用在血液透析患者临床治疗中的研究,以期在尽量不增加患者的经济负担的情况下,改善维持性血液透析患者营养不良及钙磷代谢紊乱的状况,提高患者预后。
本次研究选取了个性化饮食干预对血液透析患者营养及钙磷代谢的影响作为研究课题,针对个性化饮食干预对血液透析患者营养及钙磷代谢的影响展开深入分析,总结个性化饮食干预的主要内容、注意事项、应用效果,以提高血液透析患者治疗效果,为其临床推广使用提供科学依据。
研究目的:
本研究采用文献分析法对已经收集到的研究资料及成果进行汇总,总结当前临床中已经取得的成就及不足,在此基础上拟制定出简便、可行的个性化饮食干预方法,并观察其临床疗效。
研究方法:
选取南方医院血液净化中心维持性血液透析患者95例和衡阳市中心医院血液净化中心维持性血液透析患者92例为观察对象,先让患者在护士指导下填写未来三天膳食记录表,做营养调查,收集表格,同时使用NRS2002对患者进行营养状况评分、抽血查血生化(白蛋白、前白蛋白、磷、钙等)、iPTH等相关指标作为基线值。
然后根据病人具体情况制定个性化食谱,对病人进行饮食指导干预。
在进行个性化饮食干预3个月后,再次在护士指导下填写未来三天膳食记录表,做营养调查,收集表格,再复查患者营养状况评分、血生化(白蛋白、前白蛋白、磷、钙等)、iPTH等相关指标数值,以分析上述指标在干预前后的变化情况。
结果:
一、南方医院血液净化中心与衡阳市中心医院血液净化中心共187例患者个性化饮食干预前后营养状态评分分别为2.29±
0.25和1.89±
0.17分,P=0.032;
白蛋白(ALB)分别为37.66±
2.50和37.73±
3.00g/L,P=0.088;
血磷(P)分别为2.36±
0.24和2.17±
0.15mmol/L,P=0.039;
血钙(Ca)分别为2.14±
0.15和2.16±
0.20mmol/L,P=0.085;
血前白蛋白(PA)分别为299.60±
35.50和320.90±
40.20mg/L,P=0.033;
钙磷乘积(Ca*P)分别为61.25±
8.25和57.82±
5.50,P=0.028;
血iPTH分别为382.25±
55.75和281.20±
50.34pg/ml,P=0.037。
二、南方医院血液净化中心95例患者个性化饮食干预前后营养状态评分分别为2.05±
0.22和1.74±
0.17分,P=0.025;
白蛋白(ALB)分别为38.12±
2.48和38.51±
2.50g/L,P=0.083;
血磷(P)分别为2.31±
0.17和2.12±
0.15mmol/L,P=0.034;
血钙(Ca)分别为2.16±
0.14和2.18±
0.10mmol/L,P=0.088;
血前白蛋白(PA)分别为318.7±
28.50和336.47±
30.50mg/L,P=0.032;
钙磷乘积(Ca*P)分别为61.12±
8.30和57.53±
6.75,P=0.038;
血iPTH分别为375.50±
54.50和273.45±
60.00pg/ml,P=0.025。
三、衡阳市中心医院血液净化中心92例患者个性化饮食干预前后营养状态评分分别为2.53±
0.27和2.03±
0.22分,P=0.032;
白蛋白(ALB)分别为37.21±
2.25和37.32±
2.10g/L,P=0.088;
血磷(P)分别为2.42±
0.20和2.22±
0.25mmol/L,P=0.042;
血钙(Ca)分别为2.12±
0.12和2.14±
0.12mmol/L,P=0.089;
血前白蛋白(PA)分别为280.50±
30.25和305.33±
28.75mg/L,P=0.036;
钙磷乘积(Ca*P)分别为62.34±
7.78和58.12±
6.50,P=0.035;
血iPTH分别为388.70±
50.25和288.94±
58.61pg/ml,P=0.024。
四、南方医院血液净化中心与衡阳市中心医院血液净化中心在干预前营养状况及钙磷代谢指标比对,营养状态评分分别为2.05±
0.22和2.53±
0.27分,P=0.033;
2.48和37.21±
2.25g/L,P=0.045;
0.17和2.42±
0.20mmol/L,P=0.042;
0.14和2.12±
0.12mmol/L,P=0.041;
28.50和280.50±
30.25mg/L,P=0.031;
8.30和62.34±
7.78,P=0.044;
54.50和388.70±
50.25pg/ml,P=0.039。
结论:
(1)个性化饮食干预对改善维持性血透患者的钙磷代谢紊乱具有一定的改善作用,干预后血磷明显下降(P=0.039),钙磷乘积明显下降(P=0.028)、血iPTH明显下降(P=0.037);
血钙稍升高,但无统计学意义(P=0.085)。
(2)个性化饮食干预对改善维持性血透患者的营养状况具有一定的改善作用,干预后营养状态评分明显降低(P=0.032),血前白蛋白(PA)明显升高(P=0.033);
白蛋白(ALB)略有升高,但无统计学意义(P=0.088)。
(3)南方医院血液净化中心维持性血液透析患者在钙磷代谢和营养状况方面均优于衡阳市中心医院血液净化中心的维持性血液透析患者。
干预前南方医院患者相比衡阳市中心医院患者营养状态评分较低(P=0.033),白蛋白(ALB)较高(P=0.045),血磷(P)较低(P=0.042),血钙(Ca)较高(P=0.041),血前白蛋白(PA)较高(P=0.031),钙磷乘积(Ca*P)较低(P=0.044),血iPTH较低(P=0.039)。
关键词:
血液透析个性化饮食干预钙磷代谢营养状况
Personalizeddietarycalciumphosphorusmetabolisminpatientswithmaintenancehemodialysisandtheeffectofnutritionalstatus
Name:
TanWei
Supervisor:
LiuJun
ABSTRACT
Hemodialysis(hemodialysis,HD)iscurrentlyoneofthemaintreatmentapproachesforpatientswithacuteorchronicrenalfailure,andtoextendthepatient'
slifecycleandimprovetheeffectofclinicaltreatmenthasimportantapplicationvalueandpracticalsignificance.However,thecurrentdomesticandforeignmanyresearchresultsconfirmedthatthemedicalprofessionlong-termpatientstreatedwithhemodialysisduetokidneyandbodyfunctiondecline,causesthenutritionintakecapacityaffectedbysevere,theresultingcalciumphosphorusmetabolismdisorder,lowqualityofsurvival,poorprognosisandhighmortalityhasbecomeoneoftheinevitableproblemsincurrentclinical.Howtotakeeffectivemeasurestoimprovethetreatmentofhemodialysispatientswithmalnutritionstate,promptedthedisorderofcalciumphosphorusmetabolismreturntonormalhasbecomeanimportantsubjectincurrentstudyofthemedicalprofessionathomeandabroad.Althoughtherearemoreandmoreregulatingcalciumphosphorusmetabolismandreduceparathyroidhormonedrugsinthedomesticmarket,andthecurativeeffectisdistinct,butcostlypriceshavetakenatollonthedrugwidelyclinicalapplication.Withtheriseof
personalizeddietaryintervention,themedicalexpertsandscholarshavebeendevotingmoreattentiontoits,andexpanditsapplicationinthetreatmentofhemodialysispatientswithclinicalresearch,inanefforttotrynottoincreasetheeconomicburdenofpatients,improvemaintenancehemodialysispatientswithmalnutritionofcalciumandphosphorusmetabolismdisordersituation,improvetheprognosisofpatients.Thisstudyselectedthepersonalizeddietaryinterentionnutritionofcalciumandphosphorusmetabolisminpatientswithhemodialysisaffectastheresearchsubject,forpersonalizeddietaryinterventionsinhemodialysispatientsnutritionintensiveanalysisoftheinfluenceofcalciumandphosphorusmetabolism,summarizesthemaincontentofthepersonalizeddietaryinterventions,mattersneedingattention,theapplicationeffect,inordertoimprovetheeffectofhemodialysispatients,whichwillprovideascientificbasisforitsclinicaluse.
Researchpurposes:
thisstudyusingliteratureanalysismethodtoresearchdatacollectedandtheresultstocarryonthesummary,summarizedthecurrentclinicalhaveachievementsanddisadvantages,onthebasisofartificialsetissimpleandfeasiblepersonalizeddietaryinterventionmethods,andobserveitsclinicaleffect.
Methods:
selectingthesouthhospitalbloodpurificationcentermaintenancehemodialysispatients95casesandhengyangcitycentermaintenancehemodialysispatients,92casesofhospitalbloodpurificationcenterastheobservationobject,letpatientsguidedbynursestofillinthenextthreedays,dietaryrecord,donutritionsurvey,collectionform,atthesametimeusingNRS2002nutritionalstatusofpatientsscore,bloodcheckbloodbiochemical(albumin,prealbumin,phosphorus,calcium,etc.),iPTHandotherrelatedindicatorsasthebaselinevalues.Thenforpersonalizeddietonthebasisoftheconditionofthepatients,dietguidanceinterventiononthepatient.Inpersonalizeddietaryinterventionafter3months,inundertheguidanceofthenurseagaintofillinthenextthreedays,dietaryrecord,donutritionsurvey,collectionform,andthenreviewpatients'
nutritionalstatusscore,bloodbiochemical(albumin,prealbumin,phosphorus,calcium,etc.),iPTHandrelevantindexvalues,toanalyzethechangesoftheindicatorsbeforeandaftertheintervention..
Results:
First,southhospitalbloodpurificationcenterandhengyangcitycenterhospitalbloodpurificationcenter,atotalof187patientswithpersonalizeddietarynutritionstatusscorebeforeandafterinterventionwere2.29+/-0.25and1.89+/-0.17points,P=0.032;
Albumin(propagated)were37.66+/-2.50and37.73+/-3.00g/L,P=0.088;
Bloodphosphorus(P)were2.36+/-0.24and2.17+/-0.15tendency/L,P=0.039;
Bloodcalcium(Ca)were2.14+/-0.15and2.16+/-0.20tendency/L,P=0.085;
Bloodprealbumin(PA)were299.60+/-35.50and35.50+/-40.20mg/L,P=0.033;
Thecalcium-phosphorusproduct(Ca*P)were61.25+/-8.25and61.25+/-5.50,P=0.028;
BloodiPTHwere382.25+/-55.75and281.20+/-50.34pg/ml,P=0.037).
Second,southhospitalbloodpurificationcenter95patientspersonalizeddietarynutritionstatusscorebeforeandafterinterventionwere2.05+/-0.22and1.74+/-0.17points,P=0.025;
Albumin(propagated)were38.12+/-2.48and38.51+/-2.50g/L,P=0.083;
Bloodphosphorus(P)were2.31+/-0.17and2.12+/-0.15tendency/L,P=0.034;
Bloodcalcium(Ca)were2.16+/-0.14and2.18+/-0.10tendency/L,P=0.088;
Bloodprealbumin(PA)were318.7+/-28.50and28.50+/-30.50mg/L,P=0.032;
Thecalcium-phosphorusproduct(Ca*P)were61.12+/-8.30and61.12+/-6.75,P=0.038;
BloodiPTHwere375.50+/-54.50and273.45+/-60.00pg/ml,P=0.025).
Third,hengyangcenterhospitalbloodpurificationcenter,92casesofpatientswithpersonalizeddietarynutritionstatusscorebeforeandafterinterventionwere2.53+/-0.27and2.03+/-0.22,P=0.032;
Albumin(propagated)were37.21+/-2.25and37.32+/-2.10g/L,P=0.088;
Bloodphosphorus(P)were2.42+/-0.20and2.22+/-0.25tendency/L,P=0.042;
Bloodcalcium(Ca)were2.12+/-0.12and2.14+/-0.12tendency/L,P=0.089;
Bloodprealbumin(PA)were280.50+/-30.25and30.25+/-28.75mg/L,P=0.036;
Thecalcium-phosphorusproduct(Ca*P)were62.34+/-7.78and62.34+/-6.50,P=0.035;
BloodiPTHwere388.70+/-50.25and288.94+/-58.61pg/ml,P=0.024).
Fouth,southhospitalbloodpurificationcenterandhengyangcitycenterhospitalbloodpurificationcenterbeforeinterventionnutritionindexofcalciumandphosphorusmetabolism,nutritionalstatusscorewere2.05+/-0.22and2.53+/-0.27,P=0.033;
Albumin(propagated)were38.12+/-2.48and37.21+/-2.25g/L,P=0.045;
Bloodphosphorus(P)were2.31+/-0.17and2.42+/-0.20tendency/L,P=0.042;
Bloodcalcium(Ca)were2.16+/-0.14and2.12+/-0.12tendency/L,P=0.041;
Bloodprealbumin(PA)were3