标题：维持性血液透析患者营养状况及其影响因素分析

      作者：翁丽娜 1，崔益鸿 1，徐玮 2    (1海安县人民医院血液透析室，江苏 南通 226600；2江苏省人民医院血液净化中心，江苏 南京 226399)

      卷次： 2018年29卷6期

      【摘要】 目的 研究维持性血液透析患者营养状况及影响因素。方法 回顾性分析2015年5月至2017年4月在海安县人民医院血液透析室行维持性血液透析的200例患者的临床资料，观察患者基线资料、临床资料、围度、皮褶厚度、白蛋白、前白蛋白、总胆固醇、甘油三酯、血红蛋白指标水平和慢性病自我效能、抑郁焦虑、医学应对方法、家庭功能、社会支持度。引入多元Logistic逐步回归模型分析影响维持性血液透析患者营养状况的相关因素。结果 营养状况正常125例，营养不良75例，营养不良率为37.50%。影响维持性血液透析患者营养不良的单因素中，年龄≥60岁、无陪伴、月收入<3 000元/月、无医保、透析病程>60个月、透析频率每周≤2次、透析时间<4 h/次、促红细胞生成素使用频率≤2次/周、深静脉插管患者的营养不良率均高于年龄<60岁、有陪伴、月收入≥3 000元/月、有医保、透析病程≤60个月、透析频率每周>2次、透析时间4 h/次、促红细胞生成素使用频率>2次/周和动静脉内瘘的维持性血液透析患者，差异均有统计学意义(P<0.05)；慢性病自我效能低、存在抑郁焦虑、应对方法消极和家庭功能一般及社会支持度一般患者营养不良率均高于慢性病自我效能高、无抑郁焦虑、应对方法积极和家庭功能良好、社会支持度高患者，差异均有统计学意义(P<0.05)；营养不良患者上臂围度、白蛋白、前白蛋白、血红蛋白水平均低于总体水平，差异均有统计学意义(P<0.05)；二分类Logistic回归模型筛查，结果显示，陪伴、月收入、透析病程、透析频率、透析时间、促红细胞生成素使用频率、应对方法、家庭功能和社会支持度是影响维持性血液透析患者营养状况的独立危险因素(P<0.05)。结论 维持性血液透析患者营养不良风险较高，且影响因素多样。定期观察维持性血液透析患者营养状况、早期筛查与辨别影响营养状况因素、及时制定和完善相应预防措施有利于改善维持性血液透析患者营养不良状态。
      【关键词】 维持性血液透析；营养；状况；因素
      【中图分类号】 R459.5 【文献标识码】 A 【文章编号】 1003—6350（2018）06— 0773—0

5Nutritional status of maintenance hemodialysis patients and its influencing factors.
WENG Li-na 1, CUI Yi-hong 1,XU Wei 2. Hemodialysis Room, Haian County People's Hospital, Nantong 226600, Jiangsu, CHINA; 2. Blood PurificationCenter, Jiangsu Provincial People's Hospital, Nanjing 226399, Jiangsu, CHINA
【Abstract】 Objective To study the nutritional status and influence factors of patients with maintenance hemo-dialysis (MHD). Methods The clinical data of 200 patients with maintenance hemodialysis in Hemodialysis Room,Haian County People's Hospital from May 2015 to April 2017 were retrospectively analyzed. The baseline data, clinical da-ta, circumference, skinfold thickness, albumin, prealbumin, total cholesterol, triglyceride, hemoglobin index level, chronicdisease self-efficacy, depression and anxiety, medical coping methods, family function, social support were observed. Mul-tivariate logistic regression model was used to analyze the related factors affecting the nutritional status of maintenance he-modialysis patients. Results The nutritional status was normal in 125 cases, and abnormal in 75 cases, with malnutritionrate of 37.50%. Patients with age≥60 years old, without companionship, monthly income<3 000 yuan/month, no healthinsurance, dialysis course>60 months, dialysis frequency≤2 times per week, dialysis time<4 h/time, the use of erythro-poietin frequency≤2 times/week, deep vein intubation had higher, malnutrition rate than the patients with age<60 yearsold, with companionship, monthly income≥3 000 yuan/month, health insurance, dialysis duration≤60 months, dialysisfrequency>2 times per week, dialysis time 4 h/time, the use of erythropoietin>2 times/week and arteriovenous fistula (P<0.05). The malnutrition rate of patients with low chronic disease self-efficacy, depression and anxiety, negative copingmethods, poor family function, low social support were significantly higher than that of patients with high chronic dis-ease self-efficacy, without depression and anxiety, positive coping methods, good family function and high social support(P<0.05). The levels of upper arm circumference, albumin, prealbumin and hemoglobin of patients with malnutritionwere significantly lower than those of the overall level (P<0.05). Logistic regression model screening showed that com-·论 著·doi:10.3969/j.issn.1003-6350.2018.06.011基金项目：江苏省南通市科技项目(编号:MS12015081)