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  • 袁春华,陈 敏,马 莉,等.影响维持性血透患者生存质量的营养因素分析[J].同济大学学报(医学版),2022,43(1):50-55.    [点击复制]
  • YUAN Chunhua,CHEN Min,MA Li,et al.Effect of nutritional status on quality of life in patients with maintenance hemodialysis[J].同济大学学报(医学版),2022,43(1):50-55.   [点击复制]
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影响维持性血透患者生存质量的营养因素分析
袁春华,陈敏,马莉,豆瑞
0
(上海中医药大学附属岳阳中西医结合医院营养科,上海 200437;上海中医药大学附属岳阳中西医结合医院肾内科,上海 200437)
摘要:
目的 分析影响维持性血透患者生存质量的营养因素。方法 采用横断面调查研究方法,选取上海中医药大学附属岳阳中西医结合医院2018年1月—2020年12月维持性血液透析患者201例,男106例,女95例,平均年龄(62.5±11.8)岁,平均透析龄(25.4±12.3)个月。测量干体质量、身高、体质量指数(body mass index, BMI)、握力、肱三头肌皮褶厚度(triceps skinfold, TSF)、计算上臂肌围(arm muscle circumference, AMC),检测生化、血常规等指标,并采用改良定量主观整体评估表(modified quantitative subjective global assessment, MQSGA)进行营养评估,SF-36量表进行生存质量评价。结果 年龄、性别、透析龄、营养状况,对血透患者生存质量有影响,老年血透患者生存质量低于非老年患者(P<0.05)。男性患者的生存质量高于女性患者(P<0.05)。血透后,患者生存质量得到提高,但透析龄超过3年之后会有所下降。血透患者生存质量与MQSGA分数负相关和白蛋白正相关(P<0.05)。从各领域分项分数来看,血透患者生理机能与MQSGA分数负相关,与白蛋白、握力、AMC正相关;生理职能与MQSGA分数负相关,与白蛋白正相关;躯体疼痛与握力正相关;一般健康状况与MQSGA分数负相关,与握力、AMC正相关;精神健康与AMC正相关;情感职能与白蛋白正相关;社会功能与MQSGA分数负相关;精力与MQSGA分数负相关,与白蛋白、血红蛋白、AMC正相关(P<0.05)。结论 营养状况是影响患者生存质量的独立危险因素,其中患者内脏蛋白质和肌肉量贮备量对患者生存质量有较大影响。
关键词:  血液透析  生存质量  营养  改良定量主观整体评估表  蛋白质-能量营养不良
DOI:10.12289/j.issn.1008-0392.21108
投稿时间:2021-03-23
基金项目:上海市临床营养质量控制中心特殊医学用途配方食品规范应用和管理研究项目(HYZK20191201)
Effect of nutritional status on quality of life in patients with maintenance hemodialysis
YUAN Chunhua,CHEN Min,MA Li,DOU Rui
(Department of Clinical Nutrition, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437;Department of Nephrology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437)
Abstract:
Objective To analyze the impact of nutritional status on the quality of life in patients undergoing maintenance hemodialysis. Methods A total of 201 patients, 106 males and 95 females with an average age of(62.5±11.8) years, who underwent maintenance hemodialysis with an average dialysis duration of(25.4±12.3) months, in Yueyang Integrated Traditional Chinese and Western Medicine Hospital from January 2018 to December 2020, were enrolled in the study. The dry weight, height, body mass index(BMI), grip strength(HS), triceps skinfold thickness(TSF) and the upper arm muscle circumference(AMC), the biochemical and blood routine indexes were measured. The nutritional evaluation was carried out with the improved quantitative subjective global assessment(MQSGA) and the quality of life was evaluated with SF-36 scale. Results The analysis showed that age, gender, dialysis duration and nutritional status were significantly associated with the quality of life of hemodialysis patients. The quality of life of elderly patients was lower than that of non-elderly patients(P<0.05). Male patients had better quality of life than female patients(P<0.05). The quality of life improved with the increase of hemodialysis duration, but it declined after three years of hemodialysis. The QOL of patients was negatively correlated with MQSGA scores and positively correlated with blood albumin level(P<0.05). For each domain of SF-36 scale, the physical functioning(PF) of patients was negatively correlated with the MQSGA scores and positively correlated with albumin, grip strength, and AMC; the role-physical(RP) was negatively correlated with MQSGA scores and positively correlated with albumin; the bodily pain(BP) was positively correlated with grip strength; the general health status(GH) was negatively correlated with MQSGA scores and positively correlated with grip strength and AMC; the mental health(MH) was positively correlated with AMC; the role-emontional(RE) was positively correlated with albumin; the social functioning(SF) was negatively correlated with MQSGA scores; the viability(VT) was negatively correlated with MQSGA scores and positively correlated with albumin, hemoglobin and AMC(all P<0.05). Conclusion Nutritional status is an independent risk factor for the quality of life in patients with maintenance hemodialysis, particularly, the reserve of visceral protein and muscle protein have a great impact on the quality of life.
Key words:  hemodialysis  quality of life  nutrition  modified quantitative subjective global assessment  protein-energy malnutrition

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