中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (12): 694-696.doi: 10.3969/j.issn.1671-4091.2013.12.00

• 护理园地 • 上一篇    下一篇

对维持性血液透析患者开展身体测量时间的探讨

王颖,檀敏   

  1. 北京大学人民医院
  • 收稿日期:2013-09-30 修回日期:2013-10-12 出版日期:2013-12-12 发布日期:2013-12-03
  • 通讯作者: 檀敏Tanmin1964@yahoo.com.cn E-mail:tanmin1964@sina.com
  • 基金资助:

    北京大学人民医院护理科研基金资助项目基金号812232

The best period to evaluate the nutritional status in maintenance hemodialysis patients

  • Received:2013-09-30 Revised:2013-10-12 Online:2013-12-12 Published:2013-12-03

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摘要： [摘要]：目的：探讨維持性血液透析患者(Maintenance hemodialysis，MHD)评价营养状态时进行身体测量的最佳时间。方法：66例血液透析患者：中青年组53例，老年组13例；两年龄组中又根据透析间期不同的体重增长率各分为2组分别为：①透析间期体重增长≤干体重4.5%（中青年组16例，老年组7例）②透析间期体重增长>干体重4.5%（中青年组37例，老年组6例），每个月分别在透析前、后测量患者肱三头肌皮褶厚度（Triceps skinfold,TSF)，上臂围(Mid-arm circumference,MAC)，计算上臂肌围(Mid-arm muscle circumference,MAMC)，分别比较治疗前后数据的差异性。结果：①两年龄组全部透析前身体测量数据均值±标准差（?x?s）结果均大于透析后测量数据；且患者透前与透后上臂围（P=0.000）、肱三头肌皮褶厚度（P=0.000）、上臂肌围（P=0.000）的配对t检验结果均具有显著差异性；②三项身体测量指标透析前、后差值在不同透析间期体重增长率分组下均无统计学差异。结论：MHD患者测量以上数据的最佳时间应为透析后、身体无不适（如肌肉紧张，抽筋，低血压等并发症）时进行测量，以避免透析间期的体重增长的影响，从而合理实行长期的营养评估计划，有效的组织管理营养评估工作，为监测和治疗提供准确的数据。

关键词: 身体测量, 上臂围, 肱三头肌皮褶厚度, 上臂肌围

Abstract: 【Abstract】Objective To explore the best period to evaluate the nutritional status in maintenance hemodialysis (MHD) patients. Methods A total of 66 MHD patients (53 cases in the young and middle age group, and 13 cases in the older age group) were enrolled in this study. Based on the body weight gain in the interval between two sessions of dialysis, each age group was subdivided into two subgroups: patients with body weight gain > 4.5% of their dry body weight (37 cases in the young and middle age group, and 6 cases in the older age group), and those with body weight gain < 4.5% of their dry body weight (16 cases in the young and middle age group, and 7 cases in the older age group). Triceps skinfold (TSF), mid-arm circumference (MAC), and mid-arm muscle circumference (MAMC) derived from TSF and MAC were measured and compared every month before and after dialysis. Results (a) MAC, TSF and MAMC were significantly larger before dialysis than after hemodialysis (29.33±3.48cm vs. 28.78±3.40cm for MAC, t=10.091, P=0.000; 21.41±6.00mm vs. 20.57±5.92mm for TSF, t=10.590, P=0.000; 23.00±2.75cm vs. 22.52±2.47cm for MAMC, t=3.534, P=0.000) in all patients. MAC, TSF and MAMC values were significantly larger before dialysis than after dialysis in both the young and middle age subgroup and the older age subgroup; MAC value was 29.21±3.44cm vs. 28.68±3.56cm (t=8.437, P=0.000) in the young and middle age subgroup, and was 29.81±3.80cm vs. 29.19±3.69cm (t=6.009, P=0.000) in the older age subgroup; TSF value was 21.43±6.06mm vs. 20.52±5.98mm (t=9.865, P=0.000) in the young and middle age subgroup, and was 21.34±6.00mmin vs. 20.74±5.88mm (t=4.242, P=0.000) in the older age subgroup; MAMC value was 22.99±2.80cm vs. 22.50±2.47cm (t=2.953, P=0.000) in the young and middle age subgroup, and was 23.05±2.68cm vs. 22.64±2.57cm (t=5.177, P=0.000) in the older age subgroup. (b) No statistical differences were found in the influence of body weight gain on TSF, MAC and MAMC values collected before and after dialysis in the two body weight gain subgroups. Conclusion To avoid the body weight gain in the interval between two dialysis sessions, TSF, MAC and MAMC measurements should be carried out when MHD patients had no complaint of uncomfortable feelings such as muscular tension, cramps and hypotension symptoms after dialysis. These measurements provide accurate data that are helpful for long-term nutritional evaluation and management.

Key words: Body measurement, Triceps skinfold, Mid-arm circumference, Mid-arm muscle circumference