维持性血液透析患者蛋白质—能量消耗的营养干预研究

发布时间：2018-06-13 08:16

本文选题：蛋白质-能量消耗 + 营养治疗　；参考：《暨南大学》2014年硕士论文

【摘要】：目的调查维持性血液透析患者蛋白质-能量消耗的发生率；探讨营养支持对合并蛋白质-能量消耗的维持性血液透析患者营养状况的影响。方法本研究为前瞻性、随机、对照研究，首先对本医院2013年1月～12月在血液净化中心进行维持性血液透析的患者150例应用国际肾脏病与营养代谢学会推荐的蛋白质-能量消耗诊断标准进行筛查，了解蛋白质-能量消耗的发生率。然后将其中39例符合蛋白质-能量消耗者且能自主进食者，随机分为口服肠内营养补充组（口服组13例）、透析中补充脂肪乳组（脂肪乳剂组13例）和普通饮食组（对照组13例）分别进行营养干预，并监测干预前后的白蛋白、前白蛋白、转铁蛋白、C反应蛋白、血脂等生化指标、体重、腰围、腹围、上臂肌围、皮褶厚度等人体测量学指标、握力。所有患者均由营养师根据慢性肾脏病专家共识进行饮食方案设计和营养教育。结果 1.维持性血液透析患者蛋白质-能量消耗的发生率为38.5%。 2.营养干预对营养状况指标的影响口服组及脂肪乳剂组干预前后血清白蛋白、血清前白蛋白、转铁蛋白有明显升高，，差异有统计学意义（P0.05），而对照组及三组间血清白蛋白、血清前白蛋白、转铁蛋白均没有明显差异（P0.05），三组患者干预前后及三组间血红蛋白变化不明显（P0.05）。 3.营养干预对炎症指标及免疫功能的影响三组患者干预前后及三组间白细胞计数、中性粒细胞计数、C反应蛋白、淋巴细胞计数均没有明显差异（P0.05）。 4.营养干预对血脂指标的影响三组患者干预前后及三组间甘油三酯、总胆固醇、高密度脂蛋白、极低密度脂蛋白、低密度脂蛋白均没有明显差异（P0.05）。 5.营养干预对人体测量学指标的影响口服组及脂肪乳剂组治疗前后体重、上臂围、上臂肌围、握力有明显增加（P0.05），对照组及三组间体重、上臂围、上臂肌围、握力无明显差异（P0.05）。三组间干预前后及三组间体重指数、腰围、臀围、三头肌皮褶厚度、小腿围无明显差异（P0.05）。结论 1.维持性血液透析患者蛋白质-能量消耗的发生率高达38.5%； 2.口服营养和静脉补充脂肪乳剂均能改善患者的白蛋白、前白蛋白、转铁蛋白； 3.口服营养和静脉补充脂肪乳剂可改善患者体重、上臂围、上臂肌围、握力； 4.口服营养和静脉补充脂肪乳剂对患者炎症指标、免疫功能、脂质代谢均无影响。
[Abstract]:Objective to investigate the incidence of protein-energy expenditure in maintenance hemodialysis patients and to explore the effect of nutritional support on nutritional status of maintenance hemodialysis patients with protein-energy expenditure. Methods the study was prospective, randomized and controlled. First of all, 150 patients undergoing maintenance hemodialysis in our hospital from January to December 2013 were screened using the protein-energy consumption diagnostic criteria recommended by the International Society of Kidney Disease and Nutrition Metabolism. Understand the incidence of protein-energy expenditure. And then 39 of them who were protein-energy consuming and who could eat on their own. They were randomly divided into oral enteral nutrition supplement group (oral group, n = 13), fat emulsion group (n = 13) and general diet group (control group, n = 13). Transferrin C-reactive protein, blood lipid, body weight, waist circumference, abdominal circumference, upper arm muscle circumference, skinfold thickness and other anthropometric indexes, grip strength. All patients were dietetic design and nutrition education according to the common understanding of chronic kidney disease experts. Result 1. The incidence of protein-energy expenditure in maintenance hemodialysis patients was 38.5%. Effects of nutritional intervention on nutritional status the levels of serum albumin, serum prealbumin and transferrin in oral group and fat emulsion group were significantly increased before and after intervention. There was no significant difference in serum albumin, prealbumin and transferrin between the control group and the three groups, but there was no significant difference in serum albumin, prealbumin and transferrin between the three groups. There was no significant difference in hemoglobin between the three groups before and after intervention. Effects of nutritional intervention on inflammatory Indexes and immune function in three groups there was no significant difference in leukocyte count, neutrophil count, C-reactive protein and lymphocyte count between the three groups before and after intervention. Effect of nutritional intervention on Serum Lipid Indexes there was no significant difference in triglyceride, total cholesterol, high density lipoprotein, very low density lipoprotein and low density lipoprotein between the three groups before and after intervention. Effects of nutritional intervention on anthropometric indexes body weight, upper arm circumference, upper arm muscle circumference, grip strength in oral and fat emulsion groups were significantly increased before and after treatment, and weight, upper arm circumference and upper arm muscle circumference were significantly increased in control group and three groups. There was no significant difference in grip strength (P 0.05). There was no significant difference in body mass index, waist circumference, hip circumference, triceps skinfold thickness and leg circumference between the three groups before and after intervention. Conclusion 1. The incidence of protein-energy expenditure in maintenance hemodialysis patients was as high as 38.5%. Oral nutrition and intravenous fat emulsion can improve the patients with albumin, prealbumin, transferrin; 3. Oral nutrition and intravenous fat emulsion can improve the body weight, upper arm circumference, upper arm muscle circumference, grip strength; 4. Oral nutrition and intravenous fat emulsion had no effect on inflammatory index, immune function and lipid metabolism.
【学位授予单位】：暨南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5

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