本文選題：蛋白質-能量消耗 + 營養(yǎng)治療　； 參考：《暨南大學》2014年碩士論文

【摘要】：目的 調查維持性血液透析患者蛋白質-能量消耗的發(fā)生率；探討營養(yǎng)支持對合并蛋白質-能量消耗的維持性血液透析患者營養(yǎng)狀況的影響。 方法 本研究為前瞻性、隨機、對照研究，首先對本醫(yī)院2013年1月～12月在血液凈化中心進行維持性血液透析的患者150例應用國際腎臟病與營養(yǎng)代謝學會推薦的蛋白質-能量消耗診斷標準進行篩查，了解蛋白質-能量消耗的發(fā)生率。然后將其中39例符合蛋白質-能量消耗者且能自主進食者，隨機分為口服腸內營養(yǎng)補充組（口服組13例）、透析中補充脂肪乳組（脂肪乳劑組13例）和普通飲食組（對照組13例）分別進行營養(yǎng)干預，并監(jiān)測干預前后的白蛋白、前白蛋白、轉鐵蛋白、C反應蛋白、血脂等生化指標、體重、腰圍、腹圍、上臂肌圍、皮褶厚度等人體測量學指標、握力。所有患者均由營養(yǎng)師根據慢性腎臟病專家共識進行飲食方案設計和營養(yǎng)教育。 結果 1.維持性血液透析患者蛋白質-能量消耗的發(fā)生率為38.5%。 2.營養(yǎng)干預對營養(yǎng)狀況指標的影響 口服組及脂肪乳劑組干預前后血清白蛋白、血清前白蛋白、轉鐵蛋白有明顯升高，，差異有統計學意義（P0.05），而對照組及三組間血清白蛋白、血清前白蛋白、轉鐵蛋白均沒有明顯差異（P0.05），三組患者干預前后及三組間血紅蛋白變化不明顯（P0.05）。 3.營養(yǎng)干預對炎癥指標及免疫功能的影響 三組患者干預前后及三組間白細胞計數、中性粒細胞計數、C反應蛋白、淋巴細胞計數均沒有明顯差異（P0.05）。 4.營養(yǎng)干預對血脂指標的影響 三組患者干預前后及三組間甘油三酯、總膽固醇、高密度脂蛋白、極低密度脂蛋白、低密度脂蛋白均沒有明顯差異（P0.05）。 5.營養(yǎng)干預對人體測量學指標的影響 口服組及脂肪乳劑組治療前后體重、上臂圍、上臂肌圍、握力有明顯增加（P0.05），對照組及三組間體重、上臂圍、上臂肌圍、握力無明顯差異（P0.05）。三組間干預前后及三組間體重指數、腰圍、臀圍、三頭肌皮褶厚度、小腿圍無明顯差異（P0.05）。 結論 1.維持性血液透析患者蛋白質-能量消耗的發(fā)生率高達38.5%； 2.口服營養(yǎng)和靜脈補充脂肪乳劑均能改善患者的白蛋白、前白蛋白、轉鐵蛋白； 3.口服營養(yǎng)和靜脈補充脂肪乳劑可改善患者體重、上臂圍、上臂肌圍、握力； 4.口服營養(yǎng)和靜脈補充脂肪乳劑對患者炎癥指標、免疫功能、脂質代謝均無影響。
[Abstract]:Objective to investigate the incidence of protein-energy expenditure in maintenance hemodialysis patients and to explore the effect of nutritional support on nutritional status of maintenance hemodialysis patients with protein-energy expenditure. Methods the study was prospective, randomized and controlled. First of all, 150 patients undergoing maintenance hemodialysis in our hospital from January to December 2013 were screened using the protein-energy consumption diagnostic criteria recommended by the International Society of Kidney Disease and Nutrition Metabolism. Understand the incidence of protein-energy expenditure. And then 39 of them who were protein-energy consuming and who could eat on their own. They were randomly divided into oral enteral nutrition supplement group (oral group, n = 13), fat emulsion group (n = 13) and general diet group (control group, n = 13). Transferrin C-reactive protein, blood lipid, body weight, waist circumference, abdominal circumference, upper arm muscle circumference, skinfold thickness and other anthropometric indexes, grip strength. All patients were dietetic design and nutrition education according to the common understanding of chronic kidney disease experts. Result 1. The incidence of protein-energy expenditure in maintenance hemodialysis patients was 38.5%. Effects of nutritional intervention on nutritional status the levels of serum albumin, serum prealbumin and transferrin in oral group and fat emulsion group were significantly increased before and after intervention. There was no significant difference in serum albumin, prealbumin and transferrin between the control group and the three groups, but there was no significant difference in serum albumin, prealbumin and transferrin between the three groups. There was no significant difference in hemoglobin between the three groups before and after intervention. Effects of nutritional intervention on inflammatory Indexes and immune function in three groups there was no significant difference in leukocyte count, neutrophil count, C-reactive protein and lymphocyte count between the three groups before and after intervention. Effect of nutritional intervention on Serum Lipid Indexes there was no significant difference in triglyceride, total cholesterol, high density lipoprotein, very low density lipoprotein and low density lipoprotein between the three groups before and after intervention. Effects of nutritional intervention on anthropometric indexes body weight, upper arm circumference, upper arm muscle circumference, grip strength in oral and fat emulsion groups were significantly increased before and after treatment, and weight, upper arm circumference and upper arm muscle circumference were significantly increased in control group and three groups. There was no significant difference in grip strength (P 0.05). There was no significant difference in body mass index, waist circumference, hip circumference, triceps skinfold thickness and leg circumference between the three groups before and after intervention. Conclusion 1. The incidence of protein-energy expenditure in maintenance hemodialysis patients was as high as 38.5%. Oral nutrition and intravenous fat emulsion can improve the patients with albumin, prealbumin, transferrin; 3. Oral nutrition and intravenous fat emulsion can improve the body weight, upper arm circumference, upper arm muscle circumference, grip strength; 4. Oral nutrition and intravenous fat emulsion had no effect on inflammatory index, immune function and lipid metabolism.
【學位授予單位】：暨南大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R692.5

【共引文獻】

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