Construction Of Nutritional Management Program For Patients With Maintenance Hemodialysis

Objective:Based on the evidence-based nursing theory,the related evidence of nutritional management for maintenance hemodialysis patients was summarized,and the nutritional management plan for maintenance hemodialysis patients was finally constructed through two rounds of Delphi expert demonstration and plan verification evaluation,which provided the scientific basis for the majority of clinical and community medical workers to carry out nutritional management for maintenance hemodialysis patients and promoted the development of nursing science.Methods:The first part of the study was to set up a scheme construction group,retrieve the domestic and foreign databases,guide network,and the websites of relevant professional societies and organizations to obtain the relevant evidence on the nutrition management of maintenance hemodialysis patients,and evaluate,summarize and sum up the evidence to form a summary of the evidence on the nutrition management scheme of maintenance hemodialysis patients.The second part of the study was to revise the summary of evidence by two rounds of Delphi expert consultation to construct a nutrition management plan for maintenance hemodialysis patients.Part III Study In order to evaluate the clinical guidance effect and feasibility of the nutrition management plan constructed in this study,60 maintenance hemodialysis patients who met the inclusion and exclusion criteria in a blood purification center in Nanning were selected from October 2021.Thirty patients in the observation group received the nutrition management plan constructed in this study,and 30 patients in the control group received routine nutrition management from different departments.The intervention lasted for 12 weeks,and the indicators of patients before and after the intervention were evaluated.The subjective evaluation index was Modified Quantitative Subject Global Assessment,and the objective indicators were Body Mass Index、Arm muscle circumference、Serum Albumin、Hemoglobin、C-reative protein as well as those related to electrolytes and renal function.Results:1.Evidence summary of nutrition management of maintenance hemodialysis patients: Through literature search and quality evaluation,12 documents were finally included,including 3 guidelines,3 expert consensus,1 evidence summary,4 systematic reviews and 1 RCT study.After the evidence was extracted and summarized,a preliminary draft of 59 recommendations in nine dimensions was initially formed,including nutrition screening and evaluation(11 items),protein intake(2 items),calorie and dietary fiber intake(3 items),liquid and inorganic salt(3 items),trace element intake(9 items),vitamin intake(7 items),exogenous nutrient intake(11items),precautions for intake during dialysis(7 items),and other management(6 items).2.Construction of nutritional management plan for maintenance hemodialysis patients: After two rounds of Delphi expert consultation,36 items with 10 dimensions were finally formed,including screening and evaluation of nutrition(5 items),intake of protein(2 items),intake of calories and dietary fiber(4 items),dietary habit and weight control(3 items),intake of macroelements(3 items),intake of vitamins and trace elements(6 items), enteral/parenteral nutrition support(3 items),nursing care of eating during dialysis(4 items),lifestyle intervention(3 items),and follow-up and health education(3 items).In the first and second rounds,the expert positive coefficients were 0.9 and 1,the expert authority coefficient(Cr)was 0.897 and 0.920,the Kendall coordination coefficient was 0.428 and 0.436,the coefficient of variation was 0.081 and 0.009 respectively.3.Evaluation of application of the protocol: The nutritional scores of MQSGA in the observation group were lower than those in the control group,11.63±2.51 and 13.27±3.40 respectively,and the difference was statistically significant(P < 0.05).Among the objective indicators,the BMI,AMC,ALB and Hb levels in the observation group were higher than those in the control group,and the differences were statistically significant(P < 0.05).The serum calcium in the observation group was higher than that in the control group,and the serum phosphorus and serum potassium were lower than those in the control group,with the differences being statistically significant(P < 0.05).There was no significant difference in CRP,creatinine and BUN(P > 0.05).Conclusions:1.This study constructed the Nutrition Management Program for Maintenance Hemodialysis Patients based on evidence-based nursing theory and the scientific approach of the Delphi method.The program was comprehensive and scientific in content,and it could provide reference for the nutrition management of maintenance hemodialysis patients in the future.2.The nutritional management program had strong clinical significance and operability,and had an ideal effect on improving the nutritional status of maintenance hemodialysis patients.It reduced the MQSGA score,effectively improved the BMI of patients,ALB and Hb levels,and it was conducive to adjusting the electrolyte level of patients,and stable CRP and renal function level,and was worthy of promotion and application in hospital,continuity nursing and community health service center.