簡易營養評估(MNA)可有效判定血液透析患者的營養狀況

Validation of a modified MNA for assessing the nutritional status of maintenance hemodialysis patients in Taiwan

盧淑禎(Lu,Shu Jen)

指導教授 ： 蔡仲弘

亞洲大學/健康學院/長期照護研究所/碩士(2008年)

摘要

本研究比較簡易營養評估(Mini Nutritional Assessment, MNA)原量表及兩台灣修訂版使用於血液透析病患的功能。以立意取樣，對台灣南部某兩血液透析中心95名患者以結構式問卷進行個別訪談，並檢測體位及分析血液生化指標。以三版本MNA評量患者的營養風險。結果顯示三版本MNA均能有效的評估血液透析患者的營養狀況，其中又以修訂二(不含BMI題)的預測功能最強。各版本MNA之總分與血清白蛋白、透析前肌酸酐、臂中圍、小腿圍、透析時數、食慾狀況均呈顯著正相關(P<0.05)；而與慢性疾病數、處方藥物數、最近六個月住院天數均呈顯著負相關(P<0.05)。且這些相關都比其與血清白蛋白的相關更顯著，顯示其判別營養狀況的能力比白蛋白強。依MNA修訂二，血液透析患者2.1%被評估為營養不良，27.4%具營養風險。食慾狀況與修訂二的相關最高。這些結果顯示MNA可以有效的用於評估血液透析患者的營養狀況，且以修訂二最適合。血液透析患者體重變化頗大，MNA修訂二不含BMI題不必量身高體重，是一大優點。定期的篩檢，早期發現營養問題，可及時介入，避免營養不良的發生。可增進血液透析患者的生活品質亦可節省醫療開支。

關鍵字

血液透析 ； 簡易營養評估(MNA) ； 營養評估 ； HASH(0x93bb2e4)

並列摘要

The study compared the functionality of the original and the modified Mini Nutritional Assessment (MNA) for assessing the nutritional status of ambulatory hemodialysis (HD) patients in Taiwan. Using a structured questionnaire, the study elicited personal data, health-related information and answers to questions in the MNA with a structured questionnaire in 95 HD patients in two dialysis centers in southern Taiwan. Results showed that all three versions of the MNA could effectively assess the nutritional status of HD patients. The total MNA scores were positively correlated (P<0.05) with serum albumin, predialysis creatinine, dialysis time/session, appetite status, mid-arm circumference and calf-circumference, and negatively correlated (P<0.05) with the number of chronic diseases, number of prescribed medicine and length of hospital stay during the past six months. However, based on the strength of the correlations with nutritional indicators, the MNA-TII, the version without BMI, had the best functionality. Furthermore, the correlations with the MNA scores are all stronger than with serum albumin, suggesting that the MNA can better reflect nutritional status of these patients than albumin. The MNA-TII predicted 2.1% of HD patients malnourished, 27.4% at risk of malnutrition, and 70.5% normal. These results suggest that the MNA, especially the MNA-TII, might be a useful tool for routine assessment of nutritional status in HD patients. Since pinpointing true body weight is relatively difficult in HD patients, the MNA-TII has significant advantage over other tools by not involving BMI. Depressed appetite and inadequate protein and energy intakes are common among HD patients. Periodic assessment will enable timely intervention to avoid full-bloom malnutrition. It can also improve the quality of life of the HD patients and possibly also save on the healthcare cost.

並列關鍵字

Hemodialysis ； Mini Nutritional Assessment (MNA) ； nutritional assessment

參考文獻

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