| Hemodialysis(hemodialysis,HD)is currently one of the main treatment approaches for patients with acute or chronic renal failure,and to extend the patient's life cycle and improve the effect of clinical treatment has important application value and practical significance.However,the current domestic and foreign many research results confirmed that the medical profession long-term patients treated with hemodialysis due to kidney and body function decline,causes the nutrition intake capacity affected by severe,the resulting calcium phosphorus metabolism disorder,low quality of survival,poor prognosis and high mortality has become one of the inevitable problems in current clinical.How to take effective measures to improve the treatment of hemodialysis patients with malnutrition state,prompted the disorder of calcium phosphorus metabolism return to normal has become an important subject in current study of the medical profession at home and abroad.Although there are more and more regulating calcium phosphorus metabolism and reduce parathyroid hormone drugs in the domestic market,and the curative effect is distinct,but costly prices have taken a toll on the drug widely clinical application.With the rise of personalized dietary intervention,the medical experts and scholars have been devoting more attention to its,and expand its application in the treatment of hemodialysis patients with clinical research,in an effort to try not to increase the economic burden of patients,improve maintenance hemodialysis patients with malnutrition of calcium and phosphorus metabolism disorder situation,improve the prognosis of patients.This study selected the personalized dietary interention nutrition of calcium and phosphorus metabolism in patients with hemodialysis affect as the research subject,for personalized dietary interventions in hemodialysis patients nutrition intensive analysis of the influence of calcium and phosphorus metabolism,summarizes the main content of the personalized dietary interventions,matters needing attention,the application effect,in order to improve the effect of hemodialysis patients,which will provide a scientific basis for its clinical use.Research purposes:this study using literature analysis method to research data collected and the results to carry on the summary,summarized the current clinical have achievements and disadvantages,on the basis of artificial set is simple and feasible personalized dietary intervention methods,and observe its clinical effect.Methods:selecting the south hospital blood purification center maintenance hemodialysis patients 95 cases and hengyang city center maintenance hemodialysis patients,92 cases of hospital blood purification center as the observation object,let patients guided by nurses to fill in the next three days,dietary record,do nutrition survey,collection form,at the same time using NRS2002 nutritional status of patients score,blood check blood biochemical(albumin,prealbumin,phosphorus,calcium,etc.),iPTH and other related indicators as the baseline values.Then for personalized diet on the basis of the condition of the patients,diet guidance intervention on the patient.In personalized dietary intervention after 3 months,in under the guidance of the nurse again to fill in the next three days,dietary record,do nutrition survey,collection form,and then review patients' nutritional status score;blood biochemical(albumin,prealbumin,phosphorus,calcium,etc.),iPTH and relevant index values,to analyze the changes of the indicators before and after the intervention..Results:First,south hospital blood purification center and hengyang city center hospital blood purification center,a total of 187 patients with personalized dietary nutrition status score before and after intervention were 2.29 +/-0.25 and 1.89 +/-0.17 points,P = 0.032;Albumin(propagated)were 37.66 +/-2.50 and 37.73 +/-3.00 g/L,P = 0.088;Blood phosphorus(P)were 2.36 +/-0.24 and 2.17 +/-0.15 tendency/L,P = 0.039;Blood calcium(Ca)were 2.14 +/-0.15 and 2.16 +/-0.20 tendency/L,P = 0.085;Blood prealbumin(PA)were 299.60 +/-35.50 and 320.90 +/-40.20 mg/L,P = 0.033;The calcium-phosphorus product(Ca*P)were 61.25 +/-8.25 and 57.82 +/-5.50,P = 0.028;Blood iPTH were 382.25 +/-55.75 and 281.20+/-50.34pg/ml,P = 0.037.Second,south hospital blood purification center 95 patients personalized dietary nutrition status score before and after intervention were 2.05 +/-0.22 and 1.74 +/-0.17 points,P = 0.025;Albumin(propagated)were 38.12 +/-2.48 and 38.51 +/-2.50 g/L,P = 0.083;Blood phosphorus(P)were 2.31 +/-0.17 and 2.12 +/-0.15 tendency/L,P = 0.034;Blood calcium(Ca)were 2.16 +/-0.14 and 2.18 +/-0.10 tendency/L,P = 0.088;Blood prealbumin(PA)were 318.7 +/-28.50 and 336.47 +/-30.50 mg/L,P = 0.032;The calcium-phosphorus product(Ca*P)were 61.12 +/-8.30 and 57.53 +/-6.75,P = 0.038;Blood iPTH were 375.50 +/-54.50 and 273.45+/-60.00 pg/ml,P = 0.025.Third,hengyang center hospital blood purification center,92 cases of patients with personalized dietary nutrition status score before and after intervention were 2.53 +/-0.27 and 2.03 +/-0.22,P = 0.032;Albumin(propagated)were 37.21 +/-2.25 and 37.32 +/-2.10 g/L,P = 0.088;Blood phosphorus(P)were 2.42 +/-0.20 and 2.22 +/-0.25 tendency/L,P = 0.042;Blood calcium(Ca)were 2.12 +/-0.12 and 2.14 +/-0.12 tendency/L,P = 0.089;Blood prealbumin(PA)were 280.50 +/?30.25 and 305.33 +/-28.75 mg/L,P = 0.036;The calcium-phosphorus product(Ca*P)were 62.34 +/-7.78 and 58.12 +/-6.50,P = 0.035;Blood iPTH were 388.70 +/-50.25 and 288.94 +/-58.61 pg/ml,P = 0.024.Fouth,south hospital blood purification center and hengyang city center hospital blood purification center before intervention nutrition index of calcium and phosphorus metabolism,nutritional status score were 2.05 +/-0.22 and 2.53 +/?0.27,P = 0.033;Albumin(propagated)were 38.12 +/-2.48 and 37.21 +/-2.25 g/L,P = 0.045;Blood phosphorus(P)were 2.31 +/-0.17 and 2.42 +/-0.20 tendency/L,P = 0.042;Blood calcium(Ca)were 2.16 +/-0.14 and 2.12 +/-0.12 tendency/L,P=0.041;Blood prealbumin(PA)were 318.7 +/-28.50 and 280.50 +/-30.25 mg/L,P = 0.031;The calcium-phosphorus product(Ca*P)were 61.12 +/-8.30 and 62.34+/-7.78,P = 0.044;Blood iPTH were 375.50 +/-54.50 and 388.70 +/-50.25 pg/ml,P = 0.039.Conclusion:(1)personalized dietary interventions for improving the calcium phosphorus metabolism disorders of patients with maintenance hemodialysis have certain improvement effect,blood phosphorus significantly decreased after intervention(P =0.039),and the calcium-phosphorus product are significantly lower(P = 0.028),blood iPTH decreased obviously(P = 0.037);Blood calcium is a bit higher,but no statistical significance(P = 0.085).(2)personalized dietary intervention to improve maintenance hemodialysis patients can improve the nutritional status,nutritional status score significantly lower after intervention(P = 0.032),blood prealbumin(PA)increased significantly(P ?0.033).Albumin(propagated)slightly increases,but no statistical significance(P =0.088).(3)the south hospital blood purification center maintenance hemodialysis patients in calcium phosphorus metabolism and nutrition are superior to hengyang city center hospital blood purification center of maintenance hemodialysis patients.Intervention before compared with the central hospital of hengyang nanfang hospital patients lower nutrition status score(P = 0.033),higher albumin(propagated)(P =0.045),lower blood phosphorus(P)(P = 0.042),higher blood calcium(Ca)(P =0.041),high blood prealbumin(PA)(P = 0.031),the lower the calcium-phosphorus product(Ca*P)(P = 0.044),lower blood iPTH low(P = 0.039). |
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