标题：基于PG-SGA的个体化营养干预对血液透析患者营养状态及磷管理效果的影响

      作者：张延萍 1，何志婷 2，张倩 1    1.宝鸡市中心医院血液透析，陕西 宝鸡 721008；2.陕西省妇幼保健院血液透析中心，陕西 西安 710004

      卷次： 2023年34卷8期

      【摘要】 目的 探究基于患者主观整体评估量表(PG-SGA)的个性化营养干预对血液透析患者营养状态及磷管理效果的影响。方法 回顾性分析2019年6月至2022年1月于宝鸡市中心医院接受血液透析的116例慢性肾衰竭患者资料，其中常规组52例患者接受常规营养干预，观察组64例患者采用基于PG-SGA的个体化营养干预方案。比较两组患者干预前后的营养状态[包括主观综合性营养评估(SGA)、体质量指数(BMI)、血清白蛋白(ALB)、转铁蛋白(SF)和前白蛋白(PA)]、血磷、血钙水平和生活质量评分和自我管理效能评分，以及低血糖发生率。结果 两组患者的性别、年龄、病程、透析时间与疾病类型等资料比较差异均无统计学意义(P>0.05)；两组患者干预前的SGA评分、BMI、ALB、SF和PA水平比较差异均无统计学意义(P>0.05)，干预后，观察组患者的SGA评分为(9.37±1.60)分，明显低于常规组的(11.12±1.57)分，BMI、ALB、SF和 PA水平分别为(22.58±2.14) kg/m2、(40.29±4.94) g/L、(1.69±0.44) g/L和(293.65±31.77) g/L，明显高于常规组的(20.87±2.19) kg/m2、(37.59±4.31) g/L、(1.51±0.38) g/L和(280.74±29.63) g/L，差异均有统计学意义(P<0.05)；两组患者干预前的血磷和血钙水平比较差异均无统计学意义(P>0.05)，干预后，观察组患者的血磷为(1.69±0.23) mmol/L，明显低于常规组的(1.93±0.27) mmol/L，血钙为(2.46±0.16) mmol/L，明显高于常规组的(2.23±0.14) mmol/L，差异均有统计学意义(P<0.05)；两组患者干预前的生活质量评分和自我管理效能评分比较差异均无统计学意义(P>0.05)，干预后，观察组患者的生活质量评分和自我管理效能评分分别为(72.39±8.47)分和(38.77±5.21)分，明显高于常规组的(66.45±7.29)分和(34.89±4.36)分，差异均有统计学意义(P<0.05)；干预期间，观察组患者的低血糖发生率为3.13%，明显低于常规组的13.46%，差异有统计学意义(P<0.05)，但其他不良反应发生率比较差异均无统计学意义(P>0.05)。结论 基于PG-SGA的个体化营养干预能够改善接受血液透析治疗的慢性肾衰竭患者的营养状态，提高患者生活质量和自我管理效能，提升钙磷代谢效率，减少低血糖现象的发生。
      【关键词】 主观整体评估量表；营养状态；个性化；血液透析；钙磷代谢
      【中图分类号】 R471 【文献标识码】 A 【文章编号】 1003—6350（2023）08—1174—05

Effect of individualized nutritional intervention based on PG-SGA on nutritional status and phosphorusmanagement in patients undergoing hemodialysis.
ZHANG Yan-ping 1, HE Zhi-ting 2, ZHANG Qian 1. 1. Hemodialysis,Baoji Central Hospital, Baoji 721008, Shaanxi, CHINA; 2. Hemodialysis Center, Shaanxi Maternal and Child HealthHospital, Xi'an 710004, Shaanxi, CHINA
【Abstract】 Objective To explore the effect of individualized nutritional intervention based on patient-generat-ed subjective global assessment (PG-SGA) on nutritional status and phosphorus management in patients undergoing he-modialysis. Methods The clinical data of 116 patients with chronic renal failure who underwent hemodialysis in BaojiCentral Hospital from June 2019 to January 2022 were retrospectively analyzed. Among them, 52 patients in the routinegroup received routine nutritional intervention, and 64 patients in the observation group received individualized nutrition-al intervention based on PG-SGA. The nutritional status [including subjective comprehensive nutritional assessment(SGA), body mass index (BMI), serum albumin (ALB), transferrin (SF), and prealbumin (PA)], blood phosphorus, se-rum calcium level, quality of life scores, self-management efficacy scores, and the incidence of hypoglycemia were com-pared between the two groups before and after intervention. Results There was no significant difference between thetwo groups in gender, age, course of disease, dialysis time, and disease type (P>0.05). There was no statistically signif-icant difference in SGA score, BMI, ALB, SF, and PA levels between the two groups before intervention (P>0.05). Af-ter intervention, the SGA score of the patients in the observation group was (9.37±1.60) points, which was significant-ly lower than (11.12±1.57) points of the routine group; the levels of BMI, ALB, SF, and PA were (22.58±2.14) kg/m2,(40.29±4.94) g/L, (1.69±0.44) g/L, and (293.65±31.77) g/L, which were significantly higher than (20.87±2.19) kg/m2,(37.59±4.31) g/L, (1.51±0.38) g/L, and (280.74±29.63) g/L of the routine group; the differences were statistically signifi-cant (P<0.05). There was no statistically significant difference in blood phosphorus and blood calcium levels betweenthe two groups before intervention (P>0.05). After intervention, the blood phosphorus level of patients in the observationgroup was (1.69±0.23) mmol/L, which was significantly lower than (1.93±0.27) mmol/L in the routine group; the bloodcalcium level was (2.46±0.16) mmol/L, which was significantly higher than (2.23±0.14) mmol/L in the routine group;the differences were statistically significant (P<0.05). There was no statistically significant difference in the quality oflife score and self-management efficacy score between the two groups before intervention (P>0.05). After intervention,the quality of life score and self-management efficacy score in the observation group were (72.39 ± 8.47) points and(38.77±5.21) points, respectively, which were significantly higher than (66.45±7.29) points and (34.89±4.36) points inthe routine group; the differences were statistically significant (P<0.05). During the intervention period, the incidence ofhypoglycemia in the observation group was 3.13%, significantly lower than 13.46% in the routine group (P<0.05). Therewas no statistically significant difference in the incidence of other adverse reactions (P>0.05). Conclusion Applicationof individualized nutritional intervention based on PG-SGA for patients with chronic renal failure undergoing hemodialy-sis can effectively improve the nutritional status, quality of life and self-management efficacy, and reduce the rate of hy-poglycemia in patients.
      【Key words】 Patient-generated subjective global assessment; Nutritional status; Individualized; Hemodialysis;Calcium phosphorus metabolism