基于网络平台的个性化营养管理对血液透析营养不良患者的影响

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摘要目的探讨基于网络平台的个性化营养管理对维持性血液透析（MHD）营养不良患者的影响。方法选取2016年1月～2017年12月武汉大学人民医院MHD营养不良患者100例，根据随机数字表法分为对照组和观察组，每组各50例。对照组给予常规营养管理（口头宣教及营养宣教手册）+随访6个月，观察组给予常规营养管理+6个月的网络延伸个性化营养管理及随访（微信及QQ平台）。于营养管理前、营养管理后6个月分别进行营养学评估：改良定量主观整体评估表（MQSGA）营养状态评分、人体学测量、血生化检测；同时行个体化食谱的平均执行天数比较。结果营养管理前两组MQSGA评分比较，差异无统计学意义（P ＞ 0.05）；营养管理后6个月两组MQSGA评分均低于营养管理前（均P ＜ 0.05）；且观察组MQSGA评分显著低于对照组（P ＜ 0.01）。营养管理前两组肱三头肌皮皱厚度（TSF）比较，差异无统计学意义（P ＞ 0.05）。营养管理后6个月两组TSF值较营养管理前均明显增加，且观察组明显高于对照组（P ＜ 0.05）。营养管理前两组上臂肌围（AMC）比较，差异无统计学意义（P ＞ 0.05）。营养管理后6个月，观察组AMC较营养管理前明显增加（P ＜ 0.05），但对照组营养管理前后比较，差异无统计学意义（P ＞ 0.05），且观察组AMC明显高于对照组（P ＜ 0.05）。营养管理前，两组患者血清白蛋白（ALB）、转铁蛋白（TF）、血红蛋白（Hb）比较，差异无统计学意义（P ＞ 0.05），营养管理后6个月，观察组ALB、TF、Hb均高于对照组（均P ＜ 0.05）。营养管理后6个月，观察组ALB、TF、Hb较营养管理前明显增加（P ＜ 0.05）；对照组营养管理后6个月较营养管理前ALB值比较（P ＞ 0.05），对照组TF、Hb值较营养管理前增加（P ＜ 0.05）。营养管理后6个月营养食谱每月平均执行天数，观察组平均执行天数为（29.4±0.5）d高于对照组[（22.6±5.7）d]（P ＜ 0.05），观察组患者营养管理依从性明显优于对照组。结论基于网络平台的个性化营养管理对MHD患者开展院外延续护理，可提高护理依从性，改善患者营养状态。

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	曾涛1 张宁1 杨莲花2 丁万军3

关键词 ：维持性血液透析, 营养不良, 网络平台, 营养管理

Abstract：Objective To explore the influence of personalized nutrition management based on network platform on maintenance hemodialysis (MHD) malnutrition patients. Methods From January 2016 to December 2017, 100 patients with MHD malnutrition in Renmin Hospital of Wuhan University were selected. According to the method of random number table, the patients were divided into control group and observation group, 50 cases in each group. The control group was given routine nutrition management (oral education and nutrition education manual) and follow-up for 6 months, the observation group was given routine nutrition management + network extension personalized nutrition management and follow-up for 6 months (WeChat and QQ platform). Nutritional assessment were conducted before and 6 months after nutrition management, modified quantitative subjective global assessment (MQSGA) scores, anthropometry, blood biochemical test. The mean execution days of individual recipes were also compared. Results There was no significant difference in MQSGA score between the two groups before nutrition management (P ＞ 0.05); after 6 months of nutrition management, MQSGA scores in both groups were lower than before nutrition management (all P ＜ 0.05), and the MQSGA score in the observation group was significantly lower than that in the control group (P ＜ 0.01). There was no significant difference in TSF between the two groups before nutrition management (P ＞ 0.05); TSF values in both groups increased significantly 6 months after nutrition management compared with those before nutrition management, and the observation group was significantly higher than that in the control group (P ＜ 0.05). There was no significant difference in upper arm muscle circumference (AMC) between the two groups before nutrition management (P ＞ 0.05); after 6 months of nutrition management, there was significantly increased in AMC the observation group compared with that before nutrition management (P ＜ 0.05), while AMC was no significantly difference in the control group compared with that before nutrition management (P ＞ 0.05), and AMC in the observation group was significantly higher than that in the control group (P ＜ 0.05). Before nutrition management, there was no statistically significant difference in serum albumin (ALB), transferrin (TF) and hemoglobin (Hb) between the two groups (P ＞ 0.05). After 6 months of nutrition management, all biochemical indexes in the observation group were higher than those in the control group (all P ＜ 0.05). After 6 months of nutrition management, ALB, TF and Hb in the observation group were increased significantly compared with those before nutrition management (P ＜ 0.05). Compared with the ALB value before nutrition management in the control group (P ＞ 0.05), the TF and Hb value in the control group increased compared with those before nutrition management (P ＜ 0.05). After 6 months of nutrition management, the average number of days of nutrition diet execution per month in the observation group [(29.4±0.5) d] was higher than that in the control group [(22.6±5.7) d] (P ＜ 0.05), and the compliance of nutrition management in the observation group was significantly better than that in the control group. Conclusion Personalized nutrition management based on network platform can carry out out-of-hospital continuous nursing for MHD patients, which can improve nursing compliance and improve patients′ nutritional status.

Key words： Maintenance hemodialysis Malnutrition Network platform Nutrition management

基金资助:武汉大学人民医院护理科研基金项目（HL2018ZC-50）；
湖北省自然科学基金项目（2018CFB506）。

引用本文:

曾涛1 张宁1 杨莲花2 丁万军3. 基于网络平台的个性化营养管理对血液透析营养不良患者的影响[J]. 中国医药导报, 2020, 17(2): 160-164.
ZENG Tao1 ZHANG Ning1 YANG Lianhua2 DING Wanjun3. Influence of personalized nutrition management based on network platform on the patients with hemodialysis malnutrition. 中国医药导报, 2020, 17(2): 160-164.

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