维持性血液透析患者衰弱发生的危险因素及运动联合营养支持小组干预的疗效观察

doi:10.3969/j.issn.1671-4091.2022.04.016

摘要/Abstract

摘要： 【摘要】目的探讨维持性血液透析(maintenance hemodialysis，MHD)患者衰弱发生的危险因素及运动联合营养支持小组干预的疗效观察。方法选取南京市中西医结合医院和南京市中医院血液透析中心195 例MHD 患者，用Tilburg 衰弱量表筛出75 例发生衰弱，分析MHD 患者发生衰弱的影响因素；根据不同干预方式对衰弱患者分组：常规护理干预20 例(A 组)，常规护理结合单纯运动干预20 例(B 组)，常规护理结合单纯营养支持18 例(C 组)，常规护理并运动联合营养支持干预17 例(D 组)，比较干预前后患者衰弱状态的影响。结果衰弱组患者75 例(占38.46%)，其年龄、透析龄、糖尿病比例及营养风险评分高于非衰弱组(χ2/t=3.491、2.805、4.309、4.242，P＜0.001、0.006、0.038、＜0.001)。多因素回归分析显示，年龄(OR=1.041，95% CI 1.012～1.183，P =0.008)、血清白蛋白(OR=0.841，95% CI 0.812～1.192，P=0.001)、25-羟维生素D(OR=0.782，95% CI 0.223～0.892，P=0.018)、营养风险评估得分(OR =1.157，95% CI 1.092～1.523，P＜0.001)、步速(OR =0.632，95% CI 0.191～0.972，P=0.032)及握力(OR=0.767，95% CI 0.309～0.589,P=0.026)是MHD 患者衰弱发生的危险因素；干预后各组衰弱评分均下降，B、C、D 组下降程度优于A 组(t= 3.956、3.258、2.254，P＜0.001、0.002、0.036)，D 组下降程度优于B 组及C 组(t=2.463、2.421，P=0.024、0.025)。结论MHD 患者衰弱的发生与年龄、血清白蛋白、25-羟维生素D、营养风险评估得分、步速及握力相关，通过运动联合营养支持小组模式营养干预可以改善患者衰弱状态。

关键词: 血液透析, 衰弱, 影响因素, 营养小组, 抗阻运动

Abstract: 【Abstract】Objective To explore the risk factors of debilitation in maintenance hemodialysis (maintenance hemodialysis，MHD) patients and observe the efficacy of exercise combined with nutritional support group intervention. Methods 195 MHD patients who were treated in the hemodialysis center of "the 3rd degree and grade A" hospitals in Nanjing were recruited in this study, and 75 of them were screened according to the weakness diagnostic criteria of Tilburg weakness scale. Then analyze the influencing factors of debilitation in these MHD patients. According to the different intervention methods, these debilitating patients were
divided into the following groups: group A included 20 cases of routine nursing intervention; group B included 20 cases of simple exercise intervention, group C included 18 cases of simple nutrition support and group D included 17 cases of exercise combined nutrition intervention. In this study, the effects of debilitating state of patients before and after intervention were compared. Results The multivariate regression analysis shown that, age (or value (95% CI) = 1.041 (1.012～1.183), P=0.008), serum albumin [(OR value (95% CI)=0.841 (0.812～1.192), P =0.001], 25-hydroxyvitamin D [OR value (95%CI) = 0.782 (0.223～0.892), P = 0.018[, nutritional risk assessment score [or value (95% CI) = 1.157 (1.092-～1.523), P ＜ 0.001)], walking speed [OR value (95% CI) = 0.632 (0.191～0.972), P = 0.032] and grip strength [OR value (95% CI) = 0.767 (0.309～0.589), P = 0.026)] were risk factors of debilitation in MHD patients. After different interventions, the mean debilitation scores were decreased in all the groups, and the effect was better in group B, C and D than that in group A (t = 3.956, P ＜ 0.001, t= 3.258, P = 0.002, t= 0.254, P=0.036), and the effect was better in group D than that in group B and C (t = 2.463, P = 0.024, t= 2.421, P = 0.025). Conclusion The occurrence of debilitation in MHD patients was related to age, serum albumin, 25-hydroxyvitamin D, nutritional risk assessment score, walking speed and grip strength. Moreover, nutritional support combined with exercise can effectively improve the debilitation state of MHD patients.

Key words: Hemodialysis, Weakness, Influencing Factors, Nutrition group, Resistance exercise

中图分类号:

R473

黄莉娟, 李蓓, 王俊, 邓旭. 维持性血液透析患者衰弱发生的危险因素及运动联合营养支持小组干预的疗效观察[J]. 中国血液净化, 2022, 21(04): 292-295.

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