饮食干预对血液透析患者高磷血症的效果研究

发布时间：2018-11-09 17:06

【摘要】：背景:高磷血症是血液透析患者常见的并发症之一,是患者多种并发症的诱因,严重影响患者生活质量,增加其致残率和死亡率。低磷饮食作为控制血液透析患者高磷血症的主要途径之一,给患者带来诸多挑战,且其现状不理想。“食物磷金字塔”作为针对肾脏病患者低磷饮食的可视化工具,具有科学性、全面性和直观性的特点,为肾脏病患者低磷饮食提供了新思路。本研究旨在应用其对血液透析患者进行低磷饮食干预,并探讨其有效性。目的:对高磷血症的血液透析患者进行4个月的低磷饮食干预,探讨饮食干预对血液透析患者磷代谢相关指标、膳食状况及磷饮食知识的影响。方法:本研究为类实验性研究,于2017年1月～2017年5月,便利选取在北京协和医院及中国人民解放军总医院血透室规律血透且符合纳入标准的患者74例,将在每周一、三、五进行血液透析的患者纳入干预组(37例),每周二、四、六进行血液透析的患者纳入对照组(37例)。基线时,对于干预组患者,由研究者评估其膳食状况,在此基础上对患者及其家属进行时长30～40分钟的一对一低磷饮食指导,内容包括:磷的代谢、高磷血症的危害、如何正确地进行低磷饮食,同时向患者发放磷饮食知识手册和食物磷金字塔,对于对照组患者,研究者给予其常规低磷饮食干预;在干预的2～4个月,每个月对两组进行随访,对干预组患者存在的问题给予强化指导,对对照组不做特殊指导。分别在干预前、干预2个月、干预4个月采集两组患者的磷代谢相关指标、膳食状况及磷饮食知识,以评价饮食干预的效果。结果:干预4个月后,共完成71例患者的资料收集,其中干预组36例,对照组35例。研究结果显示:(1)在磷代谢相关指标方面:经过4个月的干预,干预组患者血磷水平及钙磷乘积较干预前显著降低(P0.017),且显著低于对照组(P0.01),(2)在膳食方面:干预后,干预组患者磷摄入水平及加工食品摄入量较干预前显著降低(P0.017),且显著低于对照组(P0.05),(3)在磷饮食知识方面:干预后,两组患者磷饮食知识得分均显著高于干预前(P0.017),干预组患者磷饮食知识得分显著高于对照组(P0.01)。结论:本饮食干预优于常规饮食干预,可有效降低血液透析患者的血磷水平,改善其钙磷代谢,降低其磷摄入量及加工食品摄入量,提高其磷饮食知识。磷饮食金字塔能够有效地指导血液透析患者进行低磷饮食,为临床医务人员更好地管理血液透析患者的高磷血症提供了参考。
[Abstract]:Background: hyperphosphatemia is one of the common complications in hemodialysis patients. As one of the main ways to control hyperphosphatemia in hemodialysis patients, low phosphorus diet brings many challenges to patients, and its present situation is not ideal. As a visual tool for low phosphorus diet of patients with kidney disease, "Food phosphorus Pyramid" has the characteristics of science, comprehensiveness and intuition, which provides a new way of thinking for patients with kidney disease. The purpose of this study was to investigate the effectiveness of low-phosphorus diet intervention in hemodialysis patients. Objective: to investigate the effects of dietary intervention on phosphorus metabolism, dietary status and knowledge of phosphorus diet in hemodialysis patients with hyperphosphatemia for 4 months. Methods: from January 2017 to May 2017, 74 patients with regular hemodialysis in Beijing Union Hospital and General Hospital of Chinese people's Liberation Army who met the inclusion criteria were selected from January 2017 to May 2017. The patients undergoing hemodialysis were included in the intervention group (37 cases) and the control group (37 cases) on Tuesday, fourth and sixth days. At baseline, for patients in the intervention group, the researchers assessed their dietary status and, on this basis, gave 30 to 40 minutes of one-on-one low-phosphorus diet guidance to patients and their families, including: phosphorus metabolism, the harm of hyperphosphoremia. How to correctly carry out the low-phosphorus diet, and at the same time distribute the knowledge manual of phosphorus diet and the pyramids of food phosphorus to the patients, for the control group, the researchers gave their regular low-phosphorus diet intervention; The two groups were followed up every month for 2 ~ 4 months of intervention. The patients in the intervention group were given intensive guidance, but no special guidance was given to the control group. Before intervention, 2 months and 4 months, the related indexes of phosphorus metabolism, dietary status and knowledge of phosphorus diet were collected to evaluate the effect of dietary intervention. Results: after 4 months of intervention, 71 patients were collected, including 36 cases in the intervention group and 35 cases in the control group. The results showed that: (1) after 4 months of intervention, the serum phosphorus level and calcium and phosphorus product of the patients in the intervention group were significantly lower than those before the intervention (P0.017), and significantly lower than those in the control group (P0.01). (2) in the dietary aspect: after intervention, the level of phosphorus intake and the intake of processed food in the intervention group were significantly lower than those before the intervention (P0.017), and significantly lower than that in the control group (P0.05), (3): after intervention, the level of phosphorus intake and the intake of processed food were significantly lower than that of the control group (P0.05), (3). The scores of phosphorus dietary knowledge in both groups were significantly higher than those before intervention (P0.017), and those in intervention group were significantly higher than those in control group (P0.01). Conclusion: the dietary intervention is superior to the conventional dietary intervention, which can effectively reduce the level of blood phosphorus, improve the calcium and phosphorus metabolism, decrease the intake of phosphorus and the intake of processed food, and improve the dietary knowledge of phosphorus in hemodialysis patients. The pyramids of phosphorus diet can effectively guide hemodialysis patients to carry out low phosphorus diet and provide reference for clinical medical staff to better manage hyperphosphatemia in hemodialysis patients.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

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