周舒燕 张娟娟 庄姬

[摘要] 目的 研究營养支持结合心理弹性支持对血液透析患者营养不良及身体成分的影响。 方法 选择我院2017年1月～2018年6月接受血液透析治疗的86例慢性肾衰竭患者作为本次的研究对象。两组患者均给予相同的治疗方法进行透析。对照组患者予以常规血液透视的护理与饮食干预。研究组患者在常规护理的基础上给予营养支持结合心理弹性支持。比较在干顸前与干预6个月后两组患者的血钙、血磷水平、营养指标、依从性及低血糖事件发生率。 结果 干预后研究组血磷、血钙水平明显低于对照组（P<0.05）。干预后，研究组前白蛋白、白蛋白、血清清蛋白、身体质量指数水平均明显升高，水平明显高于对照组（P<0.05）;干预后研究组主观全面评定法水平明显低于对照组（P<0.05）。干预后，两组肾脏病依从态度问卷及肾脏病行为量表评分均明显升高，且研究组肾脏病依从态度问卷及肾脏病行为量表评分明显高于对照组（P<0.05）。研究组低血糖发生率（4.35%）明显低于对照组（17.50%），差异有统计学意义（χ2=6.093，P=0.022）。 结论 营养支持结合心理弹性支持能有效提高患者的饮食依从性，改善患者的机体营养状况，更好地控制患者血磷及血糖水平，有利于改善患者的生存质量。

[关键词] 营养支持;心理弹性支持;血液透析;营养状况;钙磷代谢;低血糖

[中图分类号] R473.5          [文献标识码] B          [文章编号] 1673-9701（2020）16-0179-05

Study on the effect of nutritional support combined with psychological flexibility support on malnutrition and body composition in hemodialysis patients

ZHOU Shuyan   ZHANG Juanjuan   ZHUANG Ji

Ningbo Traditional Chinese Medicine Hospital Chronic Kidney Disease（CKD） Management Center， Ningbo   315012， China

[Abstract] Objective To study the effect of nutritional support combined with psychological flexibility support on malnutrition and body composition in hemodialysis patients. Methods 86 patients with chronic renal failure who underwent hemodialysis from January 2017 to June 2018 in our hospital were selected as the study subjects. Both groups were given the same treatment for dialysis. Patients in the control group were treated with routine blood hemodialysis and dietary intervention. Patients in the study group were given nutritional support combined with psychological flexibility support on the basis of routine care. Blood calcium， blood phosphorus levels， nutritional indicators， compliance and the incidence of hypoglycemia were compared between the two groups before and after 6 months of intervention. Results After intervention， the blood phosphorus and calcium level of the study group was significantly lower than that of the control group（P<0.05）. After intervention， the pre-albumin， albumin， serum albumin， and body mass index levels of the study group were significantly higher than those of the control group（P<0.05）. The level of subjective comprehensive assessment of patients in the study group was significantly lower than that of the control group after intervention（P<0.05）. The renal disease compliance questionnaire and the kidney disease behavior scale scores were significantly higher in both groups（P<0.05）. And the renal disease compliance questionnaire and the kidney disease behavior scale scores in the study group were significantly higher than those in the control group（P<0.05）. The incidence of hypoglycemia in patients in the study group（4.35%） was significantly lower than that in the control group（17.50%）， with significant difference（χ2=6.093， P=0.022）. Conclusion Nutritional support combined with psychological flexibility support can effectively improve the patient's dietary compliance， improve the patient's nutritional status， better control the patient's blood phosphorus and blood sugar levels， and help improve the patient's quality of life.

[Key words] Nutritional support; Psychological flexibility support; Hemodialysis; Nutritional status; Calcium and phosphorus metabolism; Hypoglycemia

目前，临床报道表明指出营养状况是影响血液透析患者预后的重要因素之一。有关研究发现，约有93.97%的血液透析患者存在轻度或中度的营养不良情况，约有4.52%的血液透析患者存在重度营养不良情况[1-2]。由于患者本身的疾病导致摄入营养物质不足，透析过程中发生的透析不充分、代谢性酸中毒及营养物质的流失等均是诱发患者营养不良的有关因素。另一方面，患者的肾脏功能受到损伤后，尿磷排泄功能受到影响，磷排除量减少，导致患者极易出现高磷血症[3]。临床处理上述问题常使用大剂量含钙磷结合剂，由于大剂量的含钙磷结合剂以及高钙透析液的应用，患者又会出现血钙升高的情况[4]。钙磷代谢紊乱会直接导致患者的血管钙化，提高患者心血管疾病的发生风险。……