中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (05): 413-416.doi: 10.3969/j.issn.1671-4091.2014.05.016

• 护理园地 • 上一篇    下一篇

30例维持性血液透析患者膳食调查

王颖,雷娟,檀敏,王立燕,杨洪杰,金咏菊,杨东旭,杨晓鈺,甘良英,蔡美顺   

  1. 北京大学人民医院血液净化中心
  • 收稿日期:2013-09-30 修回日期:2013-10-25 出版日期:2014-05-12 发布日期:2014-05-11
  • 基金资助:

    护理科研基金资助项目，基金号812232

THE dietary investigation of 30 cases of maintenance hemodialysis patients

  • Received:2013-09-30 Revised:2013-10-25 Online:2014-05-12 Published:2014-05-11

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摘要： [摘要] 目的：通过膳食调查，分析维持性血液透析(Maintenance hemodialysis, MHD)患者常见的饮食问题及相关因素，探讨膳食调查在MHD患者营养评估中的重要性。方法：随机选取30例MHD患者，应用3日称重膳食记录法（包含一个透析日、一个非透析日、一个周末），计算3日膳食营养成分摄入量，并根据摄入食物的类别对应《2005年慢性肾脏病专家营养共识》[1] 提出的营养治疗方案以及欧洲营养指南（2007）[2]提出的推荐摄入量进行膳食指导及分析。30例患者中，高磷血症患者共18例，分为两组进行研究，即高磷1组（8例，透析前血磷水平在1.7-1.97mmol/L）；高磷2组（10例，透析前血磷水平在2.01-2.65mmol/L）；高钾血症组（5例，透析前血钾水平≧5.5mmol/L）。结果：①30例患者BMI为18.5～33.6(均值为24.10±4.43)，其中消瘦患者5例，肥胖患者6例，其余患者为理想体重；此外8例存在总热量、蛋白质摄入过多， 13例存在总热量、蛋白质摄入过少，其余9例患者总热量蛋白质摄入合理。②30例患者中高磷血症患者共18例，其中高磷1组膳食磷平均摄入量高于血磷正常组（P=0.019）；高磷1组膳食蛋白质平均摄入量高于血磷正常组（P=0.010）。通过摄入的食物类别分析，高磷1组禽畜类膳食的平均摄入量高于血磷正常组（P=0.010）。③高钾血症组（5例，透析前血钾水平≧5.5mmol/L）膳食钾平均摄入量高于血钾正常组（P=0.000）。通过摄入的食物类别分析，高钾血症组薯类（P=0.000）、深色蔬菜（P=0.000）、水果（P=0.045）的平均摄入量高于血钾正常组。结论：通过膳食调查，研究者可以快速了解被调查对象的饮食结构和习惯，发现导致营养失调的主要原因，从而制定有效的护理措施，预防和改善MHD患者的营养失衡。

Abstract: Objective: By dietary investigation, the common dietary problems and relative factors of the maintenance hemodialysis(MHD) patients are analyzed, and the importance in the dietary investigation of the nutrition assessment of MHD patients is discussed. Methods 30 cases of MHD patients are randomly selected, 3-days weight dietary record method is adopted, 3-days nutritional intake amount is caculated, in reference to the nutritional treatment plan and EBPG guideline on nutrition in the《Consensus on Cronic Kidney Disease Nutrition(2005)》[1] and recommended intake amount in the《EBPG Guideline on Nutrition (2007) 》[2] according to the patients'food categories, the the dietary guidance and analysis are carried out. In the 30 patients, 18 are with hyperphosphatemia. According to the blood phosphorus level, the group 1 (8 cases, blood phosphorus level before dialysis is 1.7-1.9mmol/L), and the group 2 (10 cases, blood phosphorus level before dialysis is 2.01-2.65mmol/L) are devided. Results ① The BMI of 30 patients are between 18.5-33.6kg/m2 (24.10±4.43), 5 were of emaciation, 6 were of obesity. ② The total calorie and protein intake is irrational in some patients. 8 cases intake too much calorie and protein, and 13 cases intake too less calorie and protein. ③ The average dietary intakes of protein (65.01±4.29g)and phosphorus (883.37±60.32mg) among of 18 hyperposphatemic patients are greater than control group (51.10±3.87g,t=2.263,P=0.032；699.67±57.36mg,t=2.097,P= 0.045). ④ In the hyperphosphatemia group 1, the mean dietary phosphorus intake (1041.51 ± 87.62mg, F= 6.857 ,P=0.004), mean dietary protein intake (73.76±5.49g, F=5.177, P=0.012), and mean animal-related protein intake(171.50±20.00g, F=3.429,P=0.047) are all higher than the other groups.There are statistics difference; In the hyperphosphatemia group 2, the mean dietary rich intake(133.85±17.29，F=4.439，P=0.022)are higher than the other groups,There is statistics difference. Conclusion By dietary investigation, the patients'food composition and dietary habbit can be comprehended, the main cause for malnutrition can be discovered.

Key words: Dietary investigation, Maintenance, hemodialysis, Hyperphosphatemia