| Objective:To study the loss of protein,amino acids and other nutrients in peritoneal dialysis patients during peritoneal dialysis,as well as the lack of supplemental intake of protein and other nutrients after dialysis,resulting in the lack of corresponding nutrients in the body,which may be associated with the micro-inflammation in the patient’s body;explore the possible relationship to the peritoneum After a period of time,the nutritional care process of individualized high-quality protein diet for dialysis patients will change the nutritional status of peritoneal dialysis patients and the auxiliary improvement effect on the inflammatory state.Methods:This study adopts the historical control method to conduct research.The subjects of the study were peritoneal dialysis patients who attended the Peritoneal Dialysis Center of the Nephrology Department of a tertiary A hospital in Wuhan from June 2019 to December 2020.This study was implemented in the following steps:1)Formation of research team and establishment of inclusion and exclusion criteria:Establish a research team with researchers as the main force.The members of the research team determined this study on the basis of full research and discussion based on the characteristics of the clinical disease and the patient’s individual condition on the key issues such as the relevant characteristics of the peritoneal dialysis operation,the nutritional loss that may occur during the patient’s peritoneal dialysis,and the micro-inflammatory side effects.The inclusion and exclusion criteria.The specific inclusion criteria are:①Patients with peritoneal dialysis in this peritoneal dialysis center;②Patients in stable condition and clear mind;③Participating with informed consent④Patients with a survival period of more than 6 months.The exclusion criteria were:①patients who were on hemodialysis at the same time;②patients who also suffered from tumors,severe organ diseases,etc.;③patients who had very poor compliance and could not cooperate to complete the study;④patients who could not take food by mouth.2)Establish objective indicators:the nutritional status of the two groups of peritoneal dialysis patients(improved subjective nutritional risk score sheet,hemoglobin count,albumin count,body mass index(BMI),etc.),micro-inflammatory state(serum procalcitonin,white blood cell count,etc.)Lymphocyte count,etc.),the number of occurrences of peritonitis(the criteria for peritonitis in patients with peritoneal irritation,fever,and elevated white blood cell count)were evaluated,and statistical methods were used for comparison.3)Implementation plan of the control group:The research team selected peritoneal dialysis patients who were in the peritoneal dialysis center of a tertiary A hospital in Wuhan from June 2019 to December 2019 and met the inclusion and exclusion criteria as the study subjects as the control group,The final control group included 60 subjects.The peritoneal dialysis patients in the control group took regular out-of-hospital continuous nursing measures and were given regular nursing and diet guidance.The follow-up period was 6 months.When the patients in the control group undergo peritoneal dialysis for follow-up visits,the research team members will measure and record the relevant indicators of the patients.The members of the research team collected corresponding objective indicators such as nutritional status,micro-inflammatory status,and frequency of peritonitis when the control group patients were enrolled,the first month,the third month,and the sixth month of the study.4)Experimental phase:(1)Pre-experiment implementation:According to the preliminary research results of the research team,combined with the existing clinical research literature and the characteristics of the undergraduate room,and collect evaluation indicators such as nutritional status,micro-inflammatory status,and peritonitis occurrences of this group of patients.Perform data analysis on the results of the pre-experiment,and finally determine the personalized nutrition care process and implementation plan.(2)The experimental group implementation plan:According to the inclusion and exclusion criteria,60 peritoneal dialysis patients who were treated in the peritoneal dialysis center of a tertiary first-class hospital in Wuhan from June 2020 to December 2020 were selected as the experimental group.Under the routine nursing measures of the peritoneal dialysis center,the medical staff of the research team followed up the peritoneal dialysis patients in the experimental group through WeChat platform and telephone contact.The research team provided corresponding guidance to the patients and their caregivers.The main contents are:①Disease-related knowledge education:The researcher organized this group of patients to explain the possible causes of peritonitis,malnutrition,and micro-inflammation in patients with peritoneal dialysis,as well as the harm to the patient’s body,and how to effectively control the daily precautions for related complications;②Protein nutrition diet health education:give this group of patients the corresponding protein nutrition daily diet instruction;use the WeChat platform to push the corresponding instruction content once a week,including disease-related knowledge,diet instruction,life instruction,etc.According to the examination results of various objective indicators of this group of patients,the research team formulates targeted protein nutrition diet process management for this group of patients based on the feedback of the results,calculates the daily protein and energy consumption of the patients,and combines the patient’s dietary structure and Personal habits,etc.,focused on formulating a personalized diet list;this group of patients should bring their own food scales and common food calorie tables at home to teach patients or patient caregivers simple food energy conversion skills;③Remote diet guidance:members of the research team Monitor the protein nutrition diet process of this group of patients,and make a phone or WeChat video return visit to this group of patients every Thursday to inquire about the implementation of the diet plan of the patients,correct the misunderstandings of the group of patients about the implementation of the diet plan,answer patient questions,and solve the existing problems problem.The members of the research team collected corresponding objective indicators such as nutritional status,micro-inflammatory status,and the number of occurrences of peritonitis during the first month,the third month,and the sixth month when the patients were enrolled in the group.The two groups of patients spent 6 months to observe and carry out different nutrition and diet guidance and nursing procedures.The data of the two groups of patients were collected:the nutritional status of the two groups of peritoneal dialysis patients at the time of inclusion in the study(the nutritional status was scored using a modified subjective nutritional risk score table,hemoglobin count,albumin count,body mass index(BMI)),micro-inflammatory status(serum calcium reduction Suyuan PCT index,white blood cell count,lymphocyte count),the frequency of peritonitis;and the baseline data of the two groups of patients,to ensure that the difference between the two groups of patients is not statistically significant.In this study,Excel data entry was used and spss19.0 was imported for statistical analysis.The counting data were expressed as frequency,composition ratio(%),and measurement data were expressed as mean±standard deviation(x±s).All data were tested for normality;analysis of variance,t test,u test,etc.were used for measurement data that conformed to normal distribution;rank sum test of non-parametric test was used for non-normal distribution,and x2 test was used for count data.The test level of all statistical tests in the study was α=0.05.P<0.05 was considered statistically significant.Results:(1)According to the different nutritional care programs adopted by the two groups of patients,before the different care programs were given,the two groups of peritoneal dialysis patients had micro-inflammatory status indicators(serum PCT level,lymphocyte count,white blood cell count)and patient nutritional status indicators(Body mass index,nutritional status score using subjective nutritional risk score,albumin count,hemoglobin count),number of occurrences of peritonitis and general information(age,gender,education level,dialysis time)statistical results showed no statistical difference(p>0.05);(2)Comparison of the nutritional status indicators of the experimental group:During the 6-month study period,the first albumin count of the experimental group was(30±2.98),and the albumin count was(38.23±2.58)after 1 month,3 The albumin count after month was(41.56±2.85),and the albumin count after 6 months was(42.25± 1.99).The statistical analysis results were significantly different(p<0.05),which was statistically significant;the first BMI index of the experimental group(19.23±2.35),BMI(21.58± 1.55)after 1 month,BMI(22.25±2.54)after 3 months,BMI(23.77± 1.18)after 6 months,statistically significant difference(p<0.05),Statistically significant;the first hemoglobin count in the experimental group was(90.75± 10.81),the hemoglobin count after 1 month was(92.55± 1.35),the hemoglobin count after 3 months was(96.23±2.03),and the hemoglobin count after 6 months(98.77± 15.22),the statistical analysis results were significantly different(p<0.05),which was statistically significant;the first nutritional score of patients in the experimental group was(9.85±2.80),and the nutritional score after 1 month was(13.05±0.85),3 Nutrition score(11.25±0.55)after month,and nutrition score(8.98± 1.02)after 6 months,statistical analysis results are significantly different(p<0.05),which is statistically significant;(3)Comparison of inflammatory status,peritonitis occurrence times,and nutritional status of the experimental group patients at different periods:One month after the experimental group was implemented diet and nutrition care procedures,the experimental group patients’ calcitonin and peritonitis occurrence data were statistically analyzed After that,the difference was significant(p<0.05),and the difference was statistically significant;while the patient’s albumin count,BMI index,red blood cell count,nutritional score,WBC count,and lymphocyte count data were statistically analyzed,and there was no significant difference(p>0.05),the difference was not statistically significant.After 3 months of implementing the diet and nursing process for the experimental group,the statistical data of the inflammatory state,nutritional status,and peritonitis occurrences of the experimental group were statistically analyzed,and there were significant differences in the physiological indicators of the patients(p<0.05).There is statistical significance.(4)Comparison of micro-inflammatory status indicators in the experimental group.During the 6-month study period,the first PCT(0.68±0.05)of the experimental group,PCT(0.52±0.02)after 1 month,and PCT at 3 months After(0.50±0.01),6 months later,PCT(0.49± 1.65),statistical analysis results were significantly different(p<0.05),which was statistically significant;the first white blood cell count in the experimental group(9.76±2.30),one month After white blood cell count(9.35±2.55),white blood cell count(7.66±3.25)after 3 months,white blood cell count(5.68±3.55)after 6 months,there is a statistically significant difference(p<0.05),which is statistically significant;experiment In group patients,the first lymphocyte count was(0.55±0.25),the lymphocyte count after 1 month was(0.50±0.73),the lymphocyte count after 3 months was(0.48±0.58),and the mphocyte count after 6 months was(0.35±0.09),the statistical analysis results are significantly different(p<0.05),which is statistically significant;(5)Peritonitis in the experimental group compared with within the group:During the 6-month study period,the number of peritonitis in the experimental group for the first time(0.05±0.22),and the number of peritonitis after 1 month(0.01 ±0.12),3 The number of occurrences of peritonitis after one month(0.01 ±0.05),and the number of occurrences of peritonitis after six months is(0.01 ±0.03).The statistical analysis results are significantly different(p<0.05),which is statistically significant;(6)Comparison of micro-inflammatory status indicators between the two groups of patients:By the end of the study,the serum procalcitonin PCT(0.49±0.02)of the experimental group was significantly lower than the PCT of the control group(0.81 ±0.02),and the white blood cell count of the experimental group was(5.68±3.55)Lower than the white blood cell count of the control group(9.85±2.33);The lymphocyte count of the experimental group(0.35±0.09)was lower than the control group(1.38±0.05);the statistical results were significantly different(p<0.05),Statistically significant;(7)Comparison of nutritional status indicators between the two groups:By the end of the study,the albumin count of the experimental group(42.25± 1.99)was significantly higher than that of the control group(28.65±3.22);the hemoglobin count of the experimental group(98.77± 15.22)Higher than the control group’s hemoglobin count(78.98± 12.88);the experimental group’s BMI index(23.77± 1.18)was higher than the control group’s BMI index(18.55±2.33);the experimental group’s nutritional risk score(8.98± 1.02)was lower than the control group’s nutritional risk score(12.33±2.98);the statistical results are all significantly different(p<0.05),there is statistical significance;(8)Intra-group comparison of the number of peritonitis,nutritional status,and inflammatory status of peritoneal dialysis patients in the control group:During the 6-month study period,after statistical analysis of the monitoring indicators of the patients in the control group,the number of peritonitis in the patients,The statistical results of nutritional status and inflammation status were not significantly different(p-values were greater than 0.05)and were not statistically significant.Therefore,it shows that the conventional nursing measures implemented for the control group have no effect on the occurrence of peritonitis,nutritional status,and inflammation status of patients on peritoneal dialysis.No obvious help.(9)Comparison of the frequency of peritonitis between the two groups of patients:During the study period,the number of peritonitis associated with peritonitis in the experimental group was(0.01 ±0.03)significantly lower than that of the control group(1 ± 1.51),and the statistical results were significant The difference(p<0.05)is statistically significant;(10)The inflammatory state of peritoneal dialysis patients was positively correlated with the nutritional status of peritoneal dialysis patients(r=0.526,p<0.05),and the frequency of peritonitis in peritoneal dialysis patients was significantly positively correlated with the nutritional status of peritoneal dialysis patients(r=0.741,p<0.05);(11)The risk of malnutrition in peritoneal dialysis patients is positively correlated with the patient’s age(r=0.56,p<0.05),and dialysis time(r=0.21,p<0.05);the risk level of malnutrition in peritoneal dialysis patients is related to the patient’s education level There was a negative correlation(r=-0.4,p<0.05).Conclusion:(1)The implementation of targeted diet and nutrition nursing procedures for peritoneal dialysis patients by medical staff can effectively improve the inflammatory state of peritoneal dialysis patients.(2)Medical staff can effectively improve the malnutrition status of patients by providing individualized diet and nutrition care procedures for peritoneal dialysis patients for 3 months or more;(3)The occurrence of peritoneal dialysis-related peritonitis in peritoneal dialysis patients is closely related to the malnutrition state and the patient’s inflammatory state.(4)The occurrence of peritonitis in peritoneal dialysis patients is related to the patient’s culture,dialysis time,and age. |
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