摘要
目的 评价递增式抗阻运动联合营养治疗应用于接受维持性血液透析(MHD)治疗的终末期肾脏病(ESRD)患者的效果.方法 本研究为回顾性分析,选取2023年1月至2023年6月在唐山中心医院接受MHD治疗的ESRD患者120例,按照随机数字表法将其分为3组,即对照组(常规治疗)、营养治疗组(营养治疗)和营养运动组(递增式抗阻运动联合营养治疗),每组各40例.评价治疗6个月后3组的人体测量指标[身高、体重、体重指数、肱三头肌皮褶厚度(TSF)、上臂中围(MAC)、上臂肌围(MAMC)、营养指标(血红蛋白、前白蛋白和转铁蛋白)、主观综合性营养评估法(SGA)评分、6 min步行试验(6MWT)、"坐-立"体位试验(STS 10)]、生活质量[简明健康状况调查表(SF-36)]及不良事件发生情况等,并进行统计比较.结果 营养运动组体重指数、TSF、MAC和MAMC分别为(23.29±2.34)kg/m2、(12.56±1.88)mm、(26.37±2.20)cm、(22.42±2.01)cm,均明显高于对照组[(20.03±2.16)kg/m2、(9.74±1.81)mm、(22.10±2.04)cm、(19.04±1.88)cm]和营养治疗组[(21.14±2.51)kg/m2、(10.17±1.80)mm、(23.89±2.31)cm、(20.70±1.96)cm],差异均有统计学意义(P＜0.05).营养运动组血红蛋白、前白蛋白、转铁蛋白水平分别为(105.59±16.46)g/L、(311.44±80.36)mg/L、(1.85±0.31)g/L,均明显高于对照组[(91.14±18.23)g/L、(247.01 ±77.35)mg/L、(1.55±0.29)g/L]和营养治疗组[(97.79±15.80)g/L、(271.44±81.16)mg/L、(1.70±0.32)g/L],SGA评分为(9.01±1.54)分,明显低于对照组[(12.60±4.98)分]和营养治疗组[(11.24±1.71)分],差异均有统计学意义(P＜0.05).营养运动组6MWT和握力分别为(420.61±82.35)m、(28.48±3.93)kg,均明显高于对照组[(362.75±72.87)m、(16.59±4.11)kg]和营养治疗组[(377.08±79.53)m、(19.04±4.29)kg],STS 10 为(22.17± 2.03)s,明显低于对照组[(25.29±2.40)s]和营养治疗组[(23.95±2.26)s],差异均有统计学意义(P＜0.05).营养运动组SF-36量表评分为(77.05±9.10)分,明显高于对照组[(61.81±7.79)分]和营养治疗组[(71.36±8.82)分],差异均有统计学意义(P＜0.05).营养治疗组和营养运动组总不良事件发生率为15.00％、7.50％,显著低于对照组(42.50％),营养运动组低血压发生率为2.50％,显著低于对照组(17.50％),差异均有统计学意义(P＜0.05),营养治疗组和营养运动组不良事件发生率比较差异均无统计学意义(P＞0.05).结论 递增式抗阻运动联合营养治疗可有效改善接受MHD治疗的ESRD患者的营养状况、躯体功能和生活质量,减少不良事件的发生.
Abstract
Objective To evaluate the effectiveness of incremental resistance exercise combined with nutritional therapy in end stage renal disease(ESRD)patients receiving maintenance hemodialysis(MHD)treatment.Methods The study was a retrospective analysis,120 ESRD patients who received MHD treatment in Tangshan Central Hospital from January 2023 to June 2023,and were divided into three groups according to the random number table method:the control group(conventional treatment),the nutritional therapy group(nutritional therapy),and the nu-tritional exercise group(incremental resistance exercise combined with nutritional therapy),with 40 cases in each group.The human measurement indicators[height,weight,body mass index,triceps skinfold thickness(TSF),mid-upper arm circumference(MAC),upper arm muscular circumference(MAMC)],nutritional indices(hemoglobin,prealbumin and transferring),subjective global assessment(SGA),6-minute walk test(6MWT),"sit-to-stand"position test(STS 10)],quality of life[short form health status questionnaire(SF-36)]after 6 months of treatment,and adverse event were compared.Results After treatment,the body mass index,TSF,MAC,and MAMC of the nutritional exercise group were(23.29±2.34)kg/m2,(12.56±1.88)mm,(26.37±2.20)cm,and(22.42±2.01)cm,respectively,which were significant-ly higher than those of the control group[(20.03±2.16)kg/m2,(9.74±1.81)mm,(22.10±2.04)cm,(19.04±1.88)cm]and the nu-tritional treatment group[(21.14±2.51)kg/m2,(10.17±1.80)mm,(23.89±2.31)cm,(20.70±1.96)cm],the differences were sta-tistically significant(P＜0.05).After treatment,the levels of hemoglobin,prealbumin,and transferrin in the nutritional exercise group were(105.59±16.46)g/L,(311.44±80.36)mg/L,and(1.85±0.31)g/L,respectively,which were significantly higher than those in the con-trol group[(91.14±18.23)g/L,(247.01±77.35)mg/L,(1.55±0.29)g/L]and the nutrition treatment group[(97.79±15.80)g/L,(271.44±81.16)mg/L,(1.70±0.32)g/L],SGA score of the nutritional exercise group was(9.01±1.54)points,which was significantly lower than that of the control group[(12.60±4.98)points]and the nutrition treatment group[(11.24±1.71)points],and the differences were statistically significant(P＜0.05).After treatment,the 6MWT and grip strength of the nutritional exercise group were(420.61±82.35)m and(28.48±3.93)kg,respectively,which were significantly higher than those of the control group[(362.75±72.87)m and(16.59±4.11)kg]and the nutritional treatment group[(377.08±79.53)m and(19.04±4.29)kg],the STS 10 was(22.17±2.03)s,which was signifi-cantly lower than that of the control group[(25.29±2.40)s]and the nutritional treatment group[(23.95±2.26)s],and the differences were statistically significant(P＜0.05).After treatment,the SF-36 score of the nutrition exercise group was(77.05±9.10)points,which was sig-nificantly higher than that of the control group[(61.81±7.79)points]and the nutrition treatment group[(71.36±8.82)points],and the differences were statistically significant(P＜0.05).The total incidence of adverse events in the nutrition treatment group and the nutrition exer-cise group were 15.00％and 7.50％,which were significantly lower than that in the control group(42.50％),the incidence of hypotension in the nutrition exercise group was 2.50％,which was significantly lower than that in the control group(17.50％),and the differences were statisti-cally significant(P＜0.05);there was no statistically significant difference in the incidence of adverse events between the nutritional therapy group and the nutritional exercise group(P＞0.05).Conclusion The combination of incremental resistance exercise and nutritional therapy can effectively improve the nutritional status,physical function and quality of life of ESRD patients receiving MHD treatment,and reduce the occur-rence of adverse events.
维普
万方数据