| Objective To put forward a individualized nutritional guidelines for maintenance hemodialysis(MHD)patients,and change eating habits.This study was to evaluate the personalized nutrition guidance to improve the nutritional status of maintenance hemodialysis patients and to improve the patient's quality of life,prolong survival time.Methods To recruit 140 maintenance hemodialysis patients whose cases are from the hemodialysis center of The fourth hospital of Jilin University,patients who are into the group take regular hemodialysis treatment more than three months and they are in stable condition.We understand the patients' nutrition status by questionnaire,physical examination and blood biochemical examination understanding evaluation.By taking responsible nurse group management,forming a healthy diet education team,systematic education,individualized diet intervention for 11 months,then take their own before-and-after study method to improve the nutritional status of patients with evaluation.Use SPSS19.0 application software for data analysis,describe the general statistical analysis;measure data using mean±standard deviation(x ±s),two groups of data variance together using t test;Count data by chi-square test;P < 0.05 is credited with statistical significance.Results :1.140 cases of the object of study,68 male cases,accounting for 48.6% of the total,72 female cases,accounting for 51.4% of the total.2.Select 140 cases with maintenance hemodialysis,form 30 to 82 years old,53 of them are less than 60 years old;87 Patients are older than 60 years,accounting for 62.1% of the total number of investigation.3.Among the research objects,55 people are under the level of primary education,accounting for 39.3%;Junior high school,33 people are under the level of middle school education,accounting for 23.6%,29 people are under the level of high school education,accounting for 20.7;23 College graduate or above,accounting for 16.4%.4.Respondents from retiree in majority,35(25.0%);Followed by domestic researchers,24(17.1%);Followed by workers(15.7%),administrative personnel(14.3%),and other professional(8.6%),and technical personnel(6.4%),medical personnel(0.7%).5.Most Respondents' incomes of a year are between 3000-4999,76(54.3%),followed by 5000-7999 yuan of 26 persons(18.6%),8000-11999 yuan of 6 persons(4.3%),8 persons(5.7%)have 12000 yuan or more.6.In 140 patients with dialysis therapy,47 cases of chronic glomerulonephritis(33.6%),35 cases of diabetic nephropathy(25%),33 cases of hypertensive nephropathy(22.1%),renal tubular interstitial lesions in 14 cases(10%),and other 13(9.3%).7.Assess the patient's condition according to the modified quantitative subjective overall assessment(MQSGA),the incidence of malnutrition was 82.1%,among them 25 cases of normal nutrition(?10 points),accounting for 17.9%;Mild-to-moderate malnutrition(11 ~ 19 points)of 102 cases(72.9%);Severe malnutrition above 13 cases(?20 points),accounting for 9.2%8.The level of maintenance hemodialysis patients with energy and protein intake was lower than the normal range,including energy intake: for the under 60-year-old male was 29.36±4.68,for women was 28.08±3.72,for above 60-year-old male was 29.34±4.61 and women was 28.42±3.98,energy intake is lower than the normal range for 98 patients,accounting for 70%;Protein intake: men was 0.88±0.27,female was 28.08±3.72,low protein in patients with 84 people,accounting for 60%;Water intake is basic in the normal range,of which the male was 1080.26±262.04,female was 848.45±199.26,normal intake of 127 people,accounting for 90.7;Potassium intakes are low,in which the male was 3.20±0.34,female was 2.94±0.35,potassium levels in patients with high intake of 101 people,accounting for 72.1%;Sodium intake level on the high side,the male was 14.92±0.19,female was 13.06±0.28,patients are high in sodium,88 people,accounting for 62.9%;Calcium intake of the male was 1045.47±227.45 in the normal range,low women was 564.63±179.06,69 people including calcium intake in the normal range,accounting for 49.3%;Phosphorus intake of male was 945.6±224.48 in the normal range,the female was 855.43±203.76,phosphorus intake in the normal range of 121 people,accounting for 86.4%.9.The objects of study dialysis patients with body mass index(BMI)in the normal range are 79 people,accounting for 56.4%;10 persons are low weight,accounting for 7.1%;7 persons are obese patients,accounting for 5.0%;overweight patients with 44,accounting for 31.5%10.The object of study before the intervention upper arm circumference(AC),upperarm muscle circumference(AMC),triceps skin fold(TSF)were lower than the normal range,AC indicator: men < 45 years of age was 20.83±3.70(cm),45 years of age was 18.41± 3.16 or higher(cm),women < 45 years of age was 19.10±0.81(cm),45 years of age was 15.57±2.93 or higher(cm);AMC men was 16.62±2.63(cm),the female was 18.04± 2.91(cm);TSF men was 4.44±3.55(cm),the female was 9.53±4.33(cm).And more than 25% in the normal range of AC,AMC is accounting for 11.4%,TSF is accounting for 19.3%.11.Before intervention,the objects are in a state of high phosphorus,blood phosphorus measurement value of 1.87±0.41,which is higher than normal patients(42.9%);Blood calcium measurement value is 2.23±0.19 in normal range;Parathyroid hormone in patients with higher than normal range(50%);Albumin nutrient overall in good condition.12.In the process of the individualized nutritional guidance,due to poor patient compliance,140 cases of patients remained 124 patients in 11 months.Compare situation of the intake of nutrients before and after,protein intake in patients increased,consumption is reduced,sodium,potassium,phosphorus intake decreased significantly,indicators above have significant difference(P < 0.05),calcium intake value changed little.All indexes have a tendency to close to normal.13.The AC,AMC and TSF values were improved after the other anthropometric parameters of the study population,but the difference was not statistically significant(p>0.05).14.Compare to the biochemical indexes,the after intervention of blood phosphorus levels are significantly lower than the before intervention of blood phosphorus levels,i PTH are lower than the before intervention,albumin increased after the intervention,the above indexes have statistical significance(p < 0.05);After the intervention of blood calcium has a rising trend,but there was no statistically significant difference(p > 0.05).15.Compare the before and after intervention,the after intervention of the blood phosphorus decreased,normal population accounts for 53.2%,albumin has increased,normal population accounts for 79.0%,and has the difference and statistically significance(p < 0.05).Conclusion:1.Maintenancing hemodialysis patients before intervention of dietary nutrients intake,body mass index,other anthropometric indicators(AC,AMC,TSF),biochemical indexes exist different degrees of malnutrition states;2.After the intervention of dietary nutrients intake,other anthropometric indicators(AC,AMC,TSF),biochemical indexes have different degrees of improvement,It also improve the malnutrition;3.By the individualized nutritional guidance,some patients with the intake of nutrients who have the unreasonable states can be corrected.Improve the knowledge level and the healthy diet of patients,improve the nutritional status of patients. |
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