基于PG-SGA的个体化营...营养状态及磷管理效果的影响_张延萍.pdf

海南医学2023年4月第34卷第8期Hainan Med J,Apr.2023,Vol.34,No.8基于PG-SGA的个体化营养干预对血液透析患者营养状态及磷管理效果的影响张延萍1，何志婷2，张倩11.宝鸡市中心医院血液透析，陕西宝鸡 721008；2.陕西省妇幼保健院血液透析中心，陕西西安 710004【摘要】目的探究基于患者主观整体评估量表(PG-SGA)的个性化营养干预对血液透析患者营养状态及磷管理效果的影响。方法回顾性分析2019年6月至2022年1月于宝鸡市中心医院接受血液透析的116例慢性肾衰竭患者资料，其中常规组52例患者接受常规营养干预，观察组64例患者采用基于PG-SGA的个体化营养干预方案。比较两组患者干预前后的营养状态包括主观综合性营养评估(SGA)、体质量指数(BMI)、血清白蛋白(ALB)、转铁蛋白(SF)和前白蛋白(PA)、血磷、血钙水平和生活质量评分和自我管理效能评分，以及低血糖发生率。结果两组患者的性别、年龄、病程、透析时间与疾病类型等资料比较差异均无统计学意义(P0.05)；两组患者干预前的SGA评分、BMI、ALB、SF和PA水平比较差异均无统计学意义(P0.05)，干预后，观察组患者的SGA评分为(9.371.60)分，明显低于常规组的(11.121.57)分，BMI、ALB、SF和PA水平分别为(22.582.14)kg/m2、(40.294.94)g/L、(1.690.44)g/L和(293.6531.77)g/L，明显高于常规组的(20.872.19)kg/m2、(37.594.31)g/L、(1.510.38)g/L和(280.7429.63)g/L，差异均有统计学意义(P0.05)，干预后，观察组患者的血磷为(1.690.23)mmol/L，明显低于常规组的(1.930.27)mmol/L，血钙为(2.460.16)mmol/L，明显高于常规组的(2.230.14)mmol/L，差异均有统计学意义(P0.05)，干预后，观察组患者的生活质量评分和自我管理效能评分分别为(72.398.47)分和(38.775.21)分，明显高于常规组的(66.457.29)分和(34.894.36)分，差异均有统计学意义(P0.05)；干预期间，观察组患者的低血糖发生率为3.13%，明显低于常规组的13.46%，差异有统计学意义(P0.05)。结论基于PG-SGA的个体化营养干预能够改善接受血液透析治疗的慢性肾衰竭患者的营养状态，提高患者生活质量和自我管理效能，提升钙磷代谢效率，减少低血糖现象的发生。【关键词】主观整体评估量表；营养状态；个性化；血液透析；钙磷代谢【中图分类号】R471【文献标识码】A【文章编号】10036350（2023）08117405Effect of individualized nutritional intervention based on PG-SGA on nutritional status and phosphorusmanagement in patients undergoing hemodialysis.ZHANG Yan-ping1,HE Zhi-ting2,ZHANG Qian1.1.Hemodialysis,Baoji Central Hospital,Baoji 721008,Shaanxi,CHINA;2.Hemodialysis Center,Shaanxi Maternal and Child HealthHospital,Xian 710004,Shaanxi,CHINA【Abstract】ObjectiveTo explore the effect of individualized nutritional intervention based on patient-generat-ed subjective global assessment(PG-SGA)on nutritional status and phosphorus management in patients undergoing he-modialysis.MethodsThe clinical data of 116 patients with chronic renal failure who underwent hemodialysis in BaojiCentral Hospital from June 2019 to January 2022 were retrospectively analyzed.Among them,52 patients in the routinegroup received routine nutritional intervention,and 64 patients in the observation group received individualized nutrition-al intervention based on PG-SGA.The nutritional status including subjective comprehensive nutritional assessment(SGA),body mass index(BMI),serum albumin(ALB),transferrin(SF),and prealbumin(PA),blood phosphorus,se-rum calcium level,quality of life scores,self-management efficacy scores,and the incidence of hypoglycemia were com-pared between the two groups before and after intervention.ResultsThere was no significant difference between thetwo groups in gender,age,course of disease,dialysis time,and disease type(P0.05).There was no statistically signif-icant difference in SGA score,BMI,ALB,SF,and PA levels between the two groups before intervention(P0.05).Af-ter intervention,the SGA score of the patients in the observation group was(9.371.60)points,which was significant-ly lower than(11.121.57)points of the routine group;the levels of BMI,ALB,SF,and PA were(22.582.14)kg/m2,(40.294.94)g/L,(1.690.44)g/L,and(293.6531.77)g/L,which were significantly higher than(20.872.19)kg/m2,护理 doi:10.3969/j.issn.1003-6350.2023.08.023基金项目：陕西省科学技术研究发展计划项目(编号:2019J16-06-01)。第一作者：张延萍(1980)，女，主管护师，主要研究方向为血液透析护理。通讯作者：张倩(1987)，女，护师，主要研究方向为血液透析护理，E-mail：zhangqian_。1174Hainan Med J,Apr.2023,Vol.34,No.8海南医学2023年4月第34卷第8期慢性肾功能衰竭患者多表现为氮质血症，除此之外该类疾病还会对其他系统造成损伤，给患者的生命健康带来了严重威胁1。维持性血液透析是治疗慢性肾衰竭的主要方式，其能够有效延长患者生命，降低患者病死率，但是长时间的血透会给患者带来较多的不良反应，如营养不良、代谢紊乱等，会严重降低患者生活质量2-3。国外对于血透患者营养支持的关注重点在于口服补充肠内营养和肠外营养支持，而国内偏向于饮食指导和营养干预4-5。患者主观整体评估量表(Patient-generated subjective global assessment，PG-SGA)是一种科学的操作性强的营养状态评估工具6，其对于患者的营养风险也有一定的评估价值，对于个性化营养干预方案的制定有重要价值。有研究证明，营养干预能够较好改善患者营养状态7，但是PG-SGA结合个体化营养干预对于血透患者的应用价值的研究不足。因此，本研究将基于PG-SGA的个体化营养干预应用于血透患者中，探讨其对血液透析患者营养状态及磷管理效果的影响，现报道如下：1资料与方法1.1一般资料回顾性分析2019年6月至2022年1月于宝鸡市中心医院接受血液透析的116例慢性肾衰竭患者资料，其中52例接受常规营养干预患者纳入常规组，64例采用基于PG-SGA的个体化营养干预方案患者纳入观察组。纳入标准：(1)符合慢性肾病诊断标准8；(2)透析时间3个月；(3)病情稳定；(4)知晓本研究且能够高度配合。排除标准：(1)有心血管疾病病史；(2)存在肾脏移植史；(3)兼有自身免疫性疾病或严重肝、肺等脏器疾病；(4)存在沟通障碍。两组患者的一般资料间比较差异均无统计学意义(P0.05)，具有可比性，见表1。(37.594.31)g/L,(1.510.38)g/L,and(280.7429.63)g/L of the routine group;the differences were statistically signifi-cant(P0.05).After intervention,the blood phosphorus level of patients in the observationgroup was(1.690.23)mmol/L,which was significantly lower than(1.930.27)mmol/L in the routine group;the bloodcalcium level was(2.460.16)mmol/L,which was significantly higher than(2.230.14)mmol/L in the routine group;the differences were statistically significant(P0.05).After intervention,the quality of life score and self-management efficacy score in the observation group were(72.398.47)points and(38.775.21)points,respectively,which were significantly higher than(66.457.29)points and(34.894.36)points inthe routine group;the differences were statistically significant(P0.05).During the intervention period,the incidence ofhypoglycemia in the observation group was 3.13%,significantly lower than 13.46%in the routine group(P0.05).ConclusionApplicationof individualized nutritional intervent