Objective To investigate the effects of individualized nutritional intervention on protein energy wasting (PEW) and quality of life in maintenance hemodialysis (MHD) patients.Methods A total of 70 patients with MHD in the Blood Purification Center of the People's Hospital of Changji from January 2016 to January 2017 were randomly assigned to individualized nutrition intervention group (group A,40 cases) and control group (group B,30 cases).Group A received nutrition education and individualized nutrition interventions from the nutrition team of doctors,dietitians and nurses.Every 3 months,group A was subjected to diet review,daily dietary analysis,data collection (anthropological indicators and biochemical indicators,to assess the status of nutritional intervention and nutritional status of the patients),nutrition follow-up and supervision.Group B received routine nutrition education for 12 months.The changes in PEW were comprehensively evaluated in 4 aspects:body mass reduction,muscle mass loss,biochemical index,insufficient protein intake and calorie intake.The quality of life of patients was assessed by the Kidney Disease Quality of Life Short Form (KDQOL-SFTM 1.3).Results ① After intervention for 12 months,the incidence of PEW in group A (40.1％) was significantly lower than that (62.5％) before intervention,and that of group B (56.1％,P＜0.05).② After intervention for 12 months,the upper arm muscle circumference,triceps skin fold thickness,grip strength,serum albumin level and caloric intake in group A were increased as compared with those before intervention.The body mass index (BMI),hemoglobin level and total cholesterol level did not change significantly.The protein intake increased.(③ After intervention for 12 months,the total score of SF-36 (67.9 ± 11.8),KDTA (67.1 ± 10.6) and the scores of their several branch dimensions in group A were significantly higher than those in group B.Conclusions Individualized nutrition intervention can effectively improve the PEW and the quality of life of MHD patients,and improve long-term prognosis.%目的 探讨个体化营养干预对维持性血液透析(maintenance hemodialysis,MHD)患者蛋白质能量消耗(protein-energy wasting,PEW)及生存质量的影响.方法 选择2016年1月至2017年1月在新疆昌吉州人民医院血液净化中心的MHD患者70例,按分层随机分为个体化营养干预组(A组40例)及对照组(B组30例).A组接受由医生、营养师及护士组成的营养小组的营养宣教以及个体化营养干预措施,每3个月进行一次饮食回顾及全日膳食分析,记录人体学指标及生化指标以评估营养干预实施状况及患者营养状态,并进行督导强化管理;B组接受常规营养宣教,干预12个月.从患者体质量降低、肌肉量丢失、生化指标、蛋白质摄入和热量摄入不足4个方面综合评判PEW状态的变化.采用肾脏病生活质量筒表评估患者生存质量.结果 ①干预12个月后,A组患者PEW发生率(40.1％)较干预前(62.5％)明显下降;与B组PEW发生率(56.1％)比较,明显降低(P＜0.05).②干预12个月后,A组患者上臂肌围、肱三头肌皮皱厚度、握力、血清白蛋白、热量摄入较干预前有所增加;体质量指数、血红蛋白、总胆固醇较干预前无明显变化,蛋白质摄入有所增加.③干预12个月后,A组患者健康相关生存质量总评分(67.9±11.8)分、肾脏疾病相关生存质量总评分(67.1±10.6)分及其分支领域评分均高于B组,差异有显著性(P＜0.05).结论 个体化营养干预能有效改善MHD患者的PEW状态,提高MHD患者的生存质量,并改善远期预后.
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