维持性血液透析合并肌少症患者运动干预方案的构建及应用

doi:10.3761/j.issn.0254-1769.2022.07.005

摘要/Abstract

摘要：

目的构建维持性血液透析合并肌少症患者透析中运动干预方案并评价其应用效果。方法基于证据总结和德尔菲专家函询法,构建维持性血液透析合并肌少症患者透析中运动干预方案。将2021年3月—7月在连云港市某三级甲等医院行维持性血液透析合并肌少症的51例患者随机分为试验组25例和对照组26例,试验组在常规护理的基础上实施透析中运动干预方案,方案包括运动前评估、运动处方、运动监测、运动相关支持和运动效果评价5个部分。对照组给予常规透析护理。干预后比较两组肌少症患病率、骨骼肌质量指数、上臂肌围、小腿围、握力、步速和简易躯体功能量表评分的差异。结果试验组干预后肌少症患病率低于对照组（P=0.014）,握力、步速、小腿围和简易躯体功能量表评分均高于对照组（P<0.05）。结论构建的维持性血液透析合并肌少症患者透析中运动干预方案科学可靠,应用该方案能有效改善患者肌少症相关指标,降低肌少症患病率,为临床护理实践提供借鉴。

关键词: 维持性血液透析, 肌少症, 透析中运动, 护理

Abstract:

Objective To construct an intradialytic exercise intervention program for maintenance hemodialysis （MHD） patients with sarcopenia,and to evaluate its effects. Methods We constructed an intradialytic exercise intervention program for MHD patients with sarcopenia based on evidence summary and Delphi method. 51 patients with sarcopenia who underwent hemodialysis in a tertiary hospital in Lianyungang from March to July 2021 were randomly divided into an experimental group（25 cases） and a control group（26 cases）. The experimental group was given the intradialytic exercise intervention program on the basis of routine nursing. The intradialytic exercise intervention program in MHD patients with sarcopenia includes 5 parts,including pre-exercise assessment,exercise prescription,exercise monitoring,exercise-related support,and exercise effect evaluation. While the control group was given routine nursing during dialysis. After the intervention,the differences in the prevalence of sarcopenia,skeletal muscle mass index,mid-arm muscle circumference,calf circumference,grip strength,usual gait speed and the short physical performance battery（SPPB） score between the 2 groups were compared to evaluate effects of the intervention. Results The prevalence of sarcopenia in the experimental group was lower than that in the control group（P=0.014）,and the grip strength,usual gait speed,calf circumference and the SPPB score were higher than those in the control group after the intervention（P<0.05）. Conclusion The intradialytic exercise intervention program for MHD patients with sarcopenia is scientific and reliable,and the application of this program can effectively improve the relevant indicators of sarcopenia and decrease the prevalence of sarcopenia,which can provide a reference for clinical nursing practice.

Key words: Maintenance Hemodialysis, Sarcopenia, Intradialytic Exercise, Nursing Care

陈管洁, 张海林, 尹丽霞, 杜晓菊, 张慧嫔, 张永萍, 周起帆. 维持性血液透析合并肌少症患者运动干预方案的构建及应用[J]. 中华护理杂志, 2022, 57(7): 798-806.

CHEN Guanjie, ZHANG Hailin, YIN Lixia, DU Xiaoju, ZHANG Huipin, ZHANG Yongping, ZHOU Qifan. Construction and application of intradialytic exercise intervention program in maintenance hemodialysis patients with sarcopenia[J]. Chinese Journal of Nursing, 2022, 57(7): 798-806.

图/表 3

表1 维持性血液透析合并肌少症患者透析中运动干预方案

Table 1 Intradialytic exercise intervention program for MHD patients with sarcopenia

表2 两组一般资料比较

Table 2 Comparison of general data between groups

表3 两组肌少症相关指标的比较

Table 3 Comparison of related indexes of sarcopenia between groups

参考文献 31

[1]	Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia:European consensus on definition and diagnosis:report of the European working group on sarcopenia in older people[J]. Age Ageing, 2010, 39(4):412-423. DOI PMID
[2]	Almushayt SJ, Hussain S, Wilkinson DJ, et al. A systematic review of the acute effects of hemodialysis on skeletal muscle perfusion,metabolism,and function[J]. Kidney Int Rep, 2020, 5(3):307-317. DOI PMID
[3]	Lamarca F, Carrero JJ, Rodrigues JC, et al. Prevalence of sarcopenia in elderly maintenance hemodialysis patients:the impact of different diagnostic criteria[J]. J Nutr Health Aging, 2014, 18(7):710-717. DOI PMID
[4]	Matsuzawa R, Yamamoto S, Suzuki Y, et al. The clinical applicability of ultrasound technique for diagnosis of sarcopenia in hemodialysis patients[J]. Clin Nutr, 2021, 40(3):1161-1167. DOI PMID
[5]	Lin YL, Liou HH, Wang CH, et al. Impact of sarcopenia and its diagnostic criteria on hospitalization and mortality in chronic hemodialysis patients:a 3-year longitudinal study[J]. Taiwan Yi Zhi, 2020, 119(7):1219-1229.
[6]	Giglio J, Kamimura MA, Lamarca F, et al. Association of sarcopenia with nutritional parameters,quality of life,hospitalization,and mortality rates of elderly patients on hemodialysis[J]. J Ren Nutr, 2018, 28(3):197-207. DOI URL
[7]	Bakaloudi DR, Siargkas A, Poulia KA, et al. The effect of exercise on nutritional status and body composition in hemodialysis:a systematic review[J]. Nutrients, 2020, 12(10):3071. DOI URL
[8]	Lopes LCC, Mota JF, Prestes J, et al. Intradialytic resistance training improves functional capacity and lean mass gain in individuals on hemodialysis:a randomized pilot trial[J]. Arch Phys Med Rehabil, 2019, 100(11):2151-2158. DOI URL
[9]	高雅靖, 单岩, 杜理平, 等. 终末期肾脏病患者肌少症的研究进展[J]. 中华护理杂志, 2019, 54(9):1423-1426.
	Gao YJ, Shan Y, Du LP, et al. Advance in research on sarcopenia in patients with end-stage renal disease[J]. Chin J Nurs, 2019, 54(9):1423-1426.
[10]	Fang HY, Burrows BT, King AC, et al. A comparison of intradialytic versus out-of-clinic exercise training programs for hemodialysis patients[J]. Blood Purif, 2020, 49(1/2):151-157. DOI URL
[11]	董志娟. 抗阻力运动对维持性血液透析患者肌少症干预效果的研究[D]. 南京:南京医科大学, 2018.
	Dong ZJ. Effects of intradialytic resistance exercise on maintenance hemodialysis patients with sarcopenia[D]. Nanjing:Nanjing Medical University, 2018.
[12]	中国医师协会康复医师分会肾康复专业委员会. 我国成人慢性肾脏病患者运动康复的专家共识[J]. 中华肾脏病杂志, 2019, 35(7):537-543.
	Chinese Medical Doctor Association Rehabilitation Physicians Branch, Professional Committee of Renal Rehabilitation. Expert consensus on exercise rehabilitation for Chinese adults with chronic kidney disease[J]. Chin J Nephro, 2019, 35(7):537-543.
[13]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994.
	Zhu Z, Hu Y, Xing WJ, et al. The composition of different types of evidence-based problems[J]. J Nurses Train, 2017, 32(21):1991-1994.
[14]	周芬, 郝玉芳, 丛雪, 等. 指南研究与评价工具AGREEⅡ及各领域分值的补充解释及思考[J]. 护理学报, 2018, 25(18):56-58.
	Zhou F, Hao YF, Cong X, et al. Supplementary interpretation and thinking of AGREE Ⅱ and score of each domain[J]. J Nurs China, 2018, 25(18):56-58.
[15]	Institute TJB. Joanna Briggs Institute Reviewers’ Manual:2016 edition[M]. Australia:The Joanna Briggs Institute, 2016.
[16]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[17]	Koufaki P, Greenwood S, Painter P, et al. The BASES expert statement on exercise therapy for people with chronic kidney disease[J]. J Sports Sci, 2015, 33(18):1902-1907. DOI URL
[18]	Smart NA, Williams AD, Levinger I, et al. Exercise & Sports Science Australia(ESSA) position statement on exercise and chronic kidney disease[J]. J Sci Med Sport, 2013, 16(5):406-411. DOI PMID
[19]	Bogataj Š, Pajek M, Pajek J, et al. Exercise-based interventions in hemodialysis patients:a systematic review with a meta-analysis of randomized controlled trials[J]. J Clin Med, 2019, 9(1):43. DOI URL
[20]	Zhang F, Zhou WQ, Sun QZ, et al. Effects of intradialytic resistance exercises on physical performance,nutrient intake and quality of life among haemodialysis people:a systematic review and meta-analysis[J]. Nurs Open, 2021, 8(2):529-538. DOI URL
[21]	Pu J, Jiang Z, Wu WH, et al. Efficacy and safety of intradialytic exercise in haemodialysis patients:a systematic review and meta-analysis[J]. BMJ Open, 2019, 9(1):e020633. DOI URL
[22]	Gomes Neto M, de Lacerda FFR, Lopes AA, et al. Intradialytic exercise training modalities on physical functioning and health-related quality of life in patients undergoing maintenance hemodialysis:systematic review and meta-analysis[J]. Clin Rehabil, 2018, 32(9):1189-1202. DOI URL
[23]	Yeh ML, Wang MH, Hsu CC, et al. Twelve-week intradialytic cycling exercise improves physical functional performance with gain in muscle strength and endurance:a randomized controlled trial[J]. Clin Rehabil, 2020, 34(7):916-926. DOI URL
[24]	Chen LK, Woo J, Assantachai P, et al. Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment[J]. J Am Med Dir Assoc, 2020, 21(3):300-307.e2. DOI URL
[25]	Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function:association with self-reported disability and prediction of mortality and nursing home admission[J]. J Gerontol, 1994, 49(2):M85-M94. DOI URL
[26]	Hall RK, Rutledge J, Luciano A, et al. Physical function assessment in older hemodialysis patients[J]. Kidney Med, 2020, 2(4):425-431. DOI URL
[27]	Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies:development and validation[J]. J Chronic Dis, 1987, 40(5):373-383. DOI PMID
[28]	Lin Y, Yang C, Chu H, et al. Association between the Charlson Comorbidity Index and the risk of 30-day unplanned readmission in patients receiving maintenance dialysis[J]. BMC Nephrol, 2019, 20(1):363. DOI PMID
[29]	Bossola M, Tazza L. Postdialysis fatigue:a frequent and debilitating symptom[J]. Semin Dial, 2016, 29(3):222-227. DOI URL
[30]	王思远, 高敏, 赵岳. 中文版慢性病治疗功能评估-疲劳量表在维持性血液透析患者中的信效度评定[J]. 中华护理杂志, 2014, 49(5):613-617.
	Wang SY, Gao M, Zhao Y. Reliability and validity of Chinese version of the Function Assessment of Chronic Illness Therapy-Fatigue(FACIT-F) in patients undergoing maintenance hemodialysis[J]. Chin J Nurs, 2014, 49(5):613-617.
[31]	孙柳, 王星燕, 李莉, 等. 血液透析患者透析过程中运动锻炼行为阶段的调查研究[J]. 中华护理杂志, 2014, 49(5):547-551.
	Sun L, Wang XY, Li L, et al. The stages of intra-dialytic exercise behavior in patients undergoing maintenance hemodialysis[J]. Chin J Nurs, 2014, 49(5):547-551.