Roy适应理论下的饮食管理对维持性腹膜透析患者饮食行为和营养状况的影响

彭丹丹; 车腾腾; 周聪; 张倜; 韩叶青

doi:10.16766/j.cnki.issn.1674-4152.003877

Roy适应理论下的饮食管理对维持性腹膜透析患者饮食行为和营养状况的影响

doi: 10.16766/j.cnki.issn.1674-4152.003877

中国人民解放军东部战区总医院肾脏病科，江苏南京 210000

基金项目:

江苏省科技项目 BK20210148

详细信息

通讯作者:
韩叶青，E-mail：lin147828@163.com

中图分类号: R459.5
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- 文章访问数: 11
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- 被引次数: 0
出版历程
- 收稿日期: 2024-03-21
- 网络出版日期: 2025-03-27

The influence of diet management under Roy adaptation theory on dietary behavior and nutritional status of maintenance peritoneal dialysis patients

Nephrology Department, Eastern Theater Command General Hospital of the People' s Liberation Army of China, Nanjing, Jiangsu 210000, China

摘要

摘要: 目的科学合理的饮食管理对维持性腹膜透析患者至关重要。本研究基于Roy适应理论构建了腹膜透析患者饮食管理方案, 旨在腹膜透析患者饮食管理开拓新路径。方法选取2020年6月-2023年6月在中国人民解放军东部战区总医院规律腹膜透析的患者189例, 采用随机数字表法分为对照组(94例, 常规饮食管理)和Roy组(95例, Roy适应理论下的饮食管理), 对比2组饮食知识和行为、营养状况。结果 Roy组干预后饮食知识评分为(17.88±3.09)分, 高于对照组的(14.56±3.45)分(P < 0.05);肾脏病饮食行为依从量表(RABQ)评分、每日蛋白质及总热量摄入量、限水及限盐合格率均优于对照组(P < 0.05);血清白蛋白(ALB)、血红蛋白(Hb)及转铁蛋白(TRF)为(40.02±5.63) g/L、(109.31±8.22) g/L、(2.38±0.56) g/L, 均高于对照组的(33.56±8.09) g/L、(96.44±16.78) g/L、(1.92±0.34) g/L (P < 0.05);人体测量学指标与对照组比较差异无统计学意义(P>0.05);营养不良发生率为25.33%(19/75), 低于对照组的41.33%(31/75, P < 0.05)。结论 Roy适应理论下的饮食管理可提高维持性腹膜透析患者饮食知识水平, 帮助患者形成良好的饮食依从行为, 有利于改善营养状况, 降低营养不良的发生风险。
- 腹膜透析 /
- 饮食管理 /
- Roy适应理论 /
- 饮食行为 /
- 营养状况
Abstract: Objective Scientific and rational diet management is very important for patients with maintenance peritoneal dialysis.In this study, the diet management scheme of peritoneal dialysis patients was constructed based on Roy's adaptation theory, aiming to open up a new path for the diet management of dialysis patients. Methods A total of 189 patients receiving regular peritoneal dialysis in the Eastern Theater General Hospital from June 2020 to June 2023 were selected and divided into the control group (94 cases with conventional diet management) and the Roy group (95 cases with diet management under Roy's adaptation theory) by random number table method.The dietary knowledge, behavior, and nutritional status of the two groups were compared. Results The post-intervention dietary knowledge score in the Roy group was 17.88 ± 3.09, which was higher than that in the control group (14.56±3.45, P < 0.05);The scores of the renal disease adherence behavior questionnaire (RABQ), daily protein and total calorie intake, and the qualified rates of restricted water and salt were better than those of control group (P < 0.05).Serum albumin (ALB), hemoglobin (Hb) and transferrin (TRF) were (40.02±5.63) g/L, (109.31±8.22) g/L, (2.38±0.56) g/L, which were higher than that of control group[(33.56±8.09) g/L, (96.44±16.78) g/L, (1.92±0.34) g/L, P < 0.05];There was no significant difference in anthropometric indexes between the Roy group and control group (P>0.05).The incidence of malnutrition was 25.33%(19/75), which was lower than that of the control group[41.33%(31/75), P < 0.05]. Conclusion Diet management under Roy's adaptation theory can improve the knowledge level of diet control in maintenance peritoneal dialysis patients, help to form a good diet compliance behavior, and is conducive to the improvement of nutritional status and reduce the occurrence of malnutrition.
- Peritoneal dialysis /
- Diet management /
- Roy adaptation theory /
- Eating behavior /
- Nutritional status

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表 1 2组维持性腹膜透析患者一般资料比较

Table 1. Comparison of the general data between the two groups of maintenance peritoneal dialysis patients

组别	例数	性别 (男/女，例)	年龄 (x±s，岁)	受教育时间 (x±s，年)	透析龄 (x±s，月)	原发病(高血压/糖尿病/肾病，例)	收缩压 (x±s，mmHg)	舒张压 (x±s，mmHg)	血磷 (x±s，mmol/L)	血钾 (x±s，mmol/L)	Kt/V (x±s)
对照组	75	40/35	44.56±4.90	11.34±2.44	18.23±3.24	21/16 / 38	136.89±20.45	90.23±10.22	2.08±0.45	4.62±0.87	1.75±0.34
Roy组	75	34/41	45.78±8.11	11.56±2.90	18.67±4.18	24/10/41	137.56±15.31	89.67±6.34	2.11±0.56	4.67±0.92	1.80±0.44
统计量		0.960^a	1.115^b	0.503^b	0.721^b	1.699^a	0.227^b	0.403^b	0.362^b	0.342^b	0.779^b
P值		0.327	0.267	0.616	0.472	0.428	0.821	0.687	0.718	0.733	0.437
注：^a为χ²值，^b为t值。1 mmHg=0.133 kPa。

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表 2 2组维持性腹膜透析患者干预前后饮食知识比较(x±s，分)

Table 2. Comparison of dietary knowledge before and after intervention between patients undergoing maintenance peritoneal dialysis(x±s, points)

组别	例数	干预前	干预后
对照组	75	13.23±2.10	14.56±3.45^b
Roy组	75	13.56±3.54	17.88±3.09^b
统计量		0.694^a	7.278^c
P值		0.489	＜0.001
注：^a为t值，^c为F值。与同组干预前比较，^bP＜0.05。

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表 3 2组维持性腹膜透析患者干预前后饮食行为比较

Table 3. Comparison of dietary behaviors between two groups of patients undergoing maintenance peritoneal dialysis before and after intervention

组别	例数	RABQ评分(x±s，分)		蛋白质[x±s，g/(kg·d)]		总热量[x±s，kJ/(kg·d)]		限水合格[例(%)]		限盐合格[例(%)]
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	75	75.76±9.45	80.23±10.34^b	0.80±0.21	0.85±0.19	145.23±15.66	144.45±18.23	39(52.00)	43(57.33)	48(64.00)	52(69.33)
Roy组	75	76.01±10.21	94.21±8.44^b	0.82±0.17	1.01±0.24^b	143.63±17.88	136.40±20.34^b	37(49.33)	60(80.00)^b	44(58.67)	63(84.00)^b
统计量		0.156^a	10.231^c	0.641^a	5.427^c	0.583^a	4.990^c	0.107^d	9.557^d	0.450^d	6.781^d
P值		0.877	＜0.001	0.523	＜0.001	0.561	＜0.001	0.744	＜0.001	0.502	＜0.001
注：^a为t值，^c为F值，^d为χ²值。与同组干预前比较，^bP＜0.05。

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表 4 2组维持性腹膜透析患者干预前后血清营养学指标比较(x±s，g/L)

Table 4. Comparison of serum nutritional indicators between two groups of patients undergoing maintenance peritoneal dialysis before and after intervention(x±s, g/L)

组别	例数	ALB		Hb		TRF
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	75	32.45±6.35	33.56±8.09	96.67±8.07	96.44±16.78	1.86±0.35	1.92±0.34
Roy组	75	32.67±7.12	40.02±5.63^b	96.80±10.34	109.31±8.22^b	1.90±0.44	2.38±0.56^b
统计量		0.199^a	9.121^c	0.086^a	9.453^c	0.616^a	10.211^c
P值		0.842	< 0.001	0.932	< 0.001	0.539	< 0.001
注：^a为t值，^c为F值。与同组干预前比较，^bP＜0.05。

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表 5 2组维持性腹膜透析患者干预前后人体测量学指标比较(x±s)

Table 5. Comparison of anthropometric indicators between two groups of patients undergoing maintenance peritoneal dialysis before and after intervention(x±s)

组别	例数	TSF(mm)		AMC(cm)		BMI
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	75	8.76±1.09	8.91±1.44	22.37±5.66	22.45±4.10	22.60±3.55	22.90±3.47
Roy组	75	8.69±2.01	9.02±2.09	22.44±7.31	23.07±5.37	22.49±3.81	22.91±4.22
统计量		0.265^a	0.487^b	0.066^a	0.890^b	0.183^a	0.115^b
P值		0.791	0.724	0.948	0.479	0.855	0.860
注：^a为t值，^b为F值。

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表 6 2组维持性腹膜透析患者干预前后营养不良发生情况[例(%)]

Table 6. The occurrence of malnutrition in maintenance peritoneal dialysis patients before and after the intervention in the two groups[cases (%)]

组别	例数	干预前	干预1个月	干预3个月
对照组	75	57(76.00)	53(70.67)	31(41.33)
Roy组	75	51(68.00)	44(58.67)	19(25.33)
χ²值		1.191	2.363	4.320
P值		0.275	0.124	0.038

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表 7 2组维持性腹膜透析患者营养不良发生情况的广义估计方程结果

Table 7. Results of generalized estimating equations for the incidence of malnutrition in two groups of patients undergoing maintenance peritoneal dialysis

组别	时间	β	SE	Waldχ²	P值	OR值	95% CI
对照组	干预1个月	1.730	0.140	1.901	0.922	1.671	1.450~2.010
	干预3个月	1.630	0.221	14.723	< 0.001	1.789	1.200~2.060
Roy组	干预1个月	2.110	0.140	2.031	0.871	1.954	1.831~2.401
	干预3个月	2.200	0.180	153.314	< 0.001	2.111	1.851~2.551
组间	干预1个月	1.540	0.181	1.891	0.921	1.567	1.190~1.901
	干预3个月	2.830	0.210	12.341	< 0.001	2.011	1.861~2.442

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