【摘要】：背景:高磷血癥是血液透析患者常見的并發(fā)癥之一,是患者多種并發(fā)癥的誘因,嚴(yán)重影響患者生活質(zhì)量,增加其致殘率和死亡率。低磷飲食作為控制血液透析患者高磷血癥的主要途徑之一,給患者帶來諸多挑戰(zhàn),且其現(xiàn)狀不理想�！笆澄锪捉鹱炙弊鳛獒槍δI臟病患者低磷飲食的可視化工具,具有科學(xué)性、全面性和直觀性的特點,為腎臟病患者低磷飲食提供了新思路。本研究旨在應(yīng)用其對血液透析患者進(jìn)行低磷飲食干預(yù),并探討其有效性。目的:對高磷血癥的血液透析患者進(jìn)行4個月的低磷飲食干預(yù),探討飲食干預(yù)對血液透析患者磷代謝相關(guān)指標(biāo)、膳食狀況及磷飲食知識的影響。方法:本研究為類實驗性研究,于2017年1月～2017年5月,便利選取在北京協(xié)和醫(yī)院及中國人民解放軍總醫(yī)院血透室規(guī)律血透且符合納入標(biāo)準(zhǔn)的患者74例,將在每周一、三、五進(jìn)行血液透析的患者納入干預(yù)組(37例),每周二、四、六進(jìn)行血液透析的患者納入對照組(37例)。基線時,對于干預(yù)組患者,由研究者評估其膳食狀況,在此基礎(chǔ)上對患者及其家屬進(jìn)行時長30～40分鐘的一對一低磷飲食指導(dǎo),內(nèi)容包括:磷的代謝、高磷血癥的危害、如何正確地進(jìn)行低磷飲食,同時向患者發(fā)放磷飲食知識手冊和食物磷金字塔,對于對照組患者,研究者給予其常規(guī)低磷飲食干預(yù);在干預(yù)的2～4個月,每個月對兩組進(jìn)行隨訪,對干預(yù)組患者存在的問題給予強(qiáng)化指導(dǎo),對對照組不做特殊指導(dǎo)。分別在干預(yù)前、干預(yù)2個月、干預(yù)4個月采集兩組患者的磷代謝相關(guān)指標(biāo)、膳食狀況及磷飲食知識,以評價飲食干預(yù)的效果。結(jié)果:干預(yù)4個月后,共完成71例患者的資料收集,其中干預(yù)組36例,對照組35例。研究結(jié)果顯示:(1)在磷代謝相關(guān)指標(biāo)方面:經(jīng)過4個月的干預(yù),干預(yù)組患者血磷水平及鈣磷乘積較干預(yù)前顯著降低(P0.017),且顯著低于對照組(P0.01),(2)在膳食方面:干預(yù)后,干預(yù)組患者磷攝入水平及加工食品攝入量較干預(yù)前顯著降低(P0.017),且顯著低于對照組(P0.05),(3)在磷飲食知識方面:干預(yù)后,兩組患者磷飲食知識得分均顯著高于干預(yù)前(P0.017),干預(yù)組患者磷飲食知識得分顯著高于對照組(P0.01)。結(jié)論:本飲食干預(yù)優(yōu)于常規(guī)飲食干預(yù),可有效降低血液透析患者的血磷水平,改善其鈣磷代謝,降低其磷攝入量及加工食品攝入量,提高其磷飲食知識。磷飲食金字塔能夠有效地指導(dǎo)血液透析患者進(jìn)行低磷飲食,為臨床醫(yī)務(wù)人員更好地管理血液透析患者的高磷血癥提供了參考。
[Abstract]:Background: hyperphosphatemia is one of the common complications in hemodialysis patients. As one of the main ways to control hyperphosphatemia in hemodialysis patients, low phosphorus diet brings many challenges to patients, and its present situation is not ideal. As a visual tool for low phosphorus diet of patients with kidney disease, "Food phosphorus Pyramid" has the characteristics of science, comprehensiveness and intuition, which provides a new way of thinking for patients with kidney disease. The purpose of this study was to investigate the effectiveness of low-phosphorus diet intervention in hemodialysis patients. Objective: to investigate the effects of dietary intervention on phosphorus metabolism, dietary status and knowledge of phosphorus diet in hemodialysis patients with hyperphosphatemia for 4 months. Methods: from January 2017 to May 2017, 74 patients with regular hemodialysis in Beijing Union Hospital and General Hospital of Chinese people's Liberation Army who met the inclusion criteria were selected from January 2017 to May 2017. The patients undergoing hemodialysis were included in the intervention group (37 cases) and the control group (37 cases) on Tuesday, fourth and sixth days. At baseline, for patients in the intervention group, the researchers assessed their dietary status and, on this basis, gave 30 to 40 minutes of one-on-one low-phosphorus diet guidance to patients and their families, including: phosphorus metabolism, the harm of hyperphosphoremia. How to correctly carry out the low-phosphorus diet, and at the same time distribute the knowledge manual of phosphorus diet and the pyramids of food phosphorus to the patients, for the control group, the researchers gave their regular low-phosphorus diet intervention; The two groups were followed up every month for 2 ~ 4 months of intervention. The patients in the intervention group were given intensive guidance, but no special guidance was given to the control group. Before intervention, 2 months and 4 months, the related indexes of phosphorus metabolism, dietary status and knowledge of phosphorus diet were collected to evaluate the effect of dietary intervention. Results: after 4 months of intervention, 71 patients were collected, including 36 cases in the intervention group and 35 cases in the control group. The results showed that: (1) after 4 months of intervention, the serum phosphorus level and calcium and phosphorus product of the patients in the intervention group were significantly lower than those before the intervention (P0.017), and significantly lower than those in the control group (P0.01). (2) in the dietary aspect: after intervention, the level of phosphorus intake and the intake of processed food in the intervention group were significantly lower than those before the intervention (P0.017), and significantly lower than that in the control group (P0.05), (3): after intervention, the level of phosphorus intake and the intake of processed food were significantly lower than that of the control group (P0.05), (3). The scores of phosphorus dietary knowledge in both groups were significantly higher than those before intervention (P0.017), and those in intervention group were significantly higher than those in control group (P0.01). Conclusion: the dietary intervention is superior to the conventional dietary intervention, which can effectively reduce the level of blood phosphorus, improve the calcium and phosphorus metabolism, decrease the intake of phosphorus and the intake of processed food, and improve the dietary knowledge of phosphorus in hemodialysis patients. The pyramids of phosphorus diet can effectively guide hemodialysis patients to carry out low phosphorus diet and provide reference for clinical medical staff to better manage hyperphosphatemia in hemodialysis patients.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R473.5

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