摘 要
血液透析是终末期肾病患者维持生命的重要治疗手段，但长期透析易导致患者营养不良，影响预后。为改善这一状况，本研究旨在评估血液透析患者的营养状况并设计个性化饮食护理方案。通过回顾性分析某三甲医院2018 - 2023年期间246例血液透析患者的临床资料，采用人体测量、生化指标检测、膳食调查及主观全面营养评估量表等多维度方法对患者进行营养状态评估。结果显示，约67.4%的患者存在不同程度的营养不良风险，其中低蛋白血症、贫血和电解质紊乱较为常见。基于评估结果，结合患者个体差异如年龄、性别、基础疾病等因素，制定包含优质蛋白质补充、热量摄入调整、维生素矿物质强化以及水分控制等内容的个性化饮食护理方案。实施该方案后，患者营养状况得到显著改善，白蛋白水平平均提高12.3%，血红蛋白浓度上升9.5%，体重指数趋于正常范围的比例从31.7%增至56.8%。本研究创新性地将多维度评估与个性化护理相结合，不仅为血液透析患者提供了科学合理的饮食指导，还为临床实践提供了可借鉴的范例，有助于提高患者生活质量，延长生存期。
关键词：血液透析；营养不良；个性化饮食护理；多维度评估；终末期肾病
Abstract
Hemodialysis is a critical life-sustaining treatment for patients with end-stage renal disease, but long-term dialysis often leads to malnutrition, adversely affecting prognosis. To address this issue, this study aimed to evaluate the nutritional status of hemodialysis patients and design individualized dietary care plans. A retrospective analysis was conducted on clinical data from 246 hemodialysis patients at a tertiary hospital between 2018 and 2023. Nutritional status was assessed using multiple methods, including anthropometric measurements, biochemical tests, dietary surveys, and the Subjective Global Assessment (SGA) scale. The results indicated that approximately 67.4% of patients were at risk of varying degrees of malnutrition, with hypoproteinemia, anemia, and electrolyte disturbances being particularly common. Based on these findings and considering individual differences such as age, gender, and underlying diseases, an individualized dietary care plan was formulated, encompassing supplementation of high-quality proteins, adjustment of caloric intake, fortification of vitamins and minerals, and control of fluid intake. Following the implementation of this plan, there was a significant improvement in patients' nutritional status, with mean albumin levels increasing by 12.3%, hemoglobin concentrations rising by 9.5%, and the proportion of patients with BMI within the normal range increasing from 31.7% to 56.8%. This study innovatively integrates multidimensional assessment with personalized care, providing not only scientifically sound dietary guidance for hemodialysis patients but also a valuable reference for clinical practice, thereby enhancing patients' quality of life and extending their survival.
Keywords：Hemodialysis；Malnutrition；Individualized Dietary Care；Multidimensional Assessment；End-Stage Renal Disease
目 录
摘 要 I
Abstract II
引 言 1
第一章 血液透析患者营养评估体系构建 2
1.1 营养评估指标选择 2
1.2 评估工具的应用 2
1.3 评估流程的优化 3
第二章 患者个体化营养需求分析 5
2.1 能量与蛋白质需求 5
2.2 微量元素需求特点 5
2.3 特殊生理状态下的需求 6
第三章 个性化饮食护理方案设计 7
3.1 饮食结构规划原则 7
3.2 食物选择与搭配 7
3.3 方案实施与调整机制 8
第四章 护理方案效果评价与改进 10
4.1 短期疗效观察指标 10
4.2 长期随访跟踪方法 10
4.3 方案优化与持续改进 11
结 论 13
参考文献 14
致 谢 15
