|摘要||目的 观察过高蛋白质摄入进行饮食调整后对腹膜透析病人营养状况的影响.方法 选取2005年7月至2006年11月期间规律随访的稳定腹透病人33例,其每日饮食蛋白质摄入(daily protein intake,DPI)均>1.2 g/(kg·d).由营养师为其制定食谱以减少蛋白质摄入.评估调整病人饮食DPI和热量摄入(daily energyintake,DEI)前后各营养指标的变化,包括血白蛋白(Alb)、瘦体重(LBM)、主观综合性营养评估(SGA),高钾、高磷和代谢性酸中毒发生的比例,以及病人生活质量和生活满意度(半定量评分方法,分为0～10分).结果 33例腹透病人6月后1人转血透,3人移植,1人死亡,共28人纳入研究.对象的平均年龄为61.4±12.3岁,男女比例分别为39.29%和60.71%.透析龄为8.8月(1～66月).饮食调整半年内DPI,DEI下降具有统计学差异.所有病人饮食调整后不伴随胃肠道症状加重,生活质量和生活满意度无变化.饮食调整半年内,血ALB在3个月后明显上升为36.22±2.79g/Lvs 37.34±3.32 g/L,P<0.05),血Scr半年后明显上升(753.91±311.02 μmol/L vs 835.93±283.39μmol/L,P=0.003),而LBM、SGA、高磷血症、高钾血症及酸中毒发生率在半年内变化均无统计学意义.结论 过高蛋白质摄入的腹透病人经营养师制定食谱指导其合理摄入蛋白质和能量后,病人营养状况稳定,生活质量和生活满意度等无变化.
Objective To observe the effect of adjusting high dietary profein intake on nutritional status of peritoneal dialysis (PD) patients. Method Thirty three PD patients whose daily protein intake (DPI) was over 1.2g/(kg· d) were included in study from July, 2005 to November, 2006. A recipe was given by a professional dietitian for every patient to reduce DPI meanwhile maintaining sufficient daily energy intake (DEI). DPI, DEI, serum albumin (ALB), lean body mass(LBM) and subjective global assessment(SGA) and the prevalence of hyperphosphatemia, hyperkalemia and metabolic acidosis were evaluated before and after 3 and 6 mo adjustment. Results At the end of observation, 28 patients were enrolled in the study. Their mean age was 61.37± 12.25 yrs, 11 males and 17 females with dialysis period 8.8 mon (1～66 mo). DPI and DEI were significantly decreased during 6 mo (P=0.000). Nobody complained about gastrointestinal symptoms, and the quality and satisfaction of life during the study were not significantly different. Serum Alb at 3 rd month was higher than the start of study (36.22±2.79g/L vs 37.34±3.32 g/L,P<0.05). Serum creatinine at 6th month was also higher than the start of study (753.91±311.02 μmmol/L vs 835.93± 283.39 μmmol/L,P=0.003). There was no significant difference in LBM and SGA. The prevalence of hyperphosphatemia, hyperkalemia or metabolic acidosis was not significantly changed during 6 mo. Conclusion Prescribing a rational recipe by a professional dietitian is an effective way to adjust the protein and calorie intake of PD patients. It does not affect the nutritional status of the patients with satisfactory quality of life.|