- 期刊
跨科部營養照護介入改善透析病人營養相關指標
Interdisciplinary Nutrition Care Intervention for Improving Nutrition-Related Indicators of Patients Undergoing Dialysis
摘要
標準化蛋白質異化代謝率（normalized protein catabolic rate，nPCR）為臨床評估透析病人蛋白質攝取量指標之一，研究指出nPCR<1.0病人的衰弱指數及死亡率較高。本研究旨在探討營養衛教對nPCR<1.0之血液透析（hemodialysis，HD）和腹膜透析（peritoneal dialysis，PD）病人的飲食攝取量、營養相關指標、nPCR和一年存活率的改善情形。本研究對象為北部某醫學中心2021年底常規HD與PD nPCR<1.0的病人，於2022年2月起進行共計3次完整營養評估與衛教。發現營養衛教介入前、後，每kg體重蛋白質攝取顯著增加（HD:1.03 ± 0.19 g vs. 1.10±0.18 g, p=0.001; PD:0.96 ± 0.16 g vs. 1.01 ± 0.17 g, p= 0.001），且血磷濃度改善（HD:4.84 ± 1.54 mg/dL vs. 4.42 ± 1.35 mg/dL, p=0.021; PD:5.54 ± 1.45 vs. 5.19 ±1.31 mg/dL, p=0.003）。比較介入前、後1個月與1年nPCR變化有顯著改善（HD:0.83 ± 0.15 vs. 0.98 ± 0.24 vs. 1.14 ± 0.29, p=0.008; PD0.84 ± 0.10 vs. 0.91 ± 0.17 vs. 0.90 ± 0.16, p=0.047）。且發現介入組（nPCR<1.0）與未介入組（nPCR≥1.0）一年存活率分別為81.6%與88.5%，統計上無顯著差異（p=0.118）。藉連續營養照護可提升透析病人蛋白質攝取量與改善血磷，營養介入後1個月nPCR改善並可維持至一年。本研究透過跨科部營養照護，營養師積極介入營養衛教以改善HD和PD病人營養相關指標。
並列摘要
The normalized protein catabolic rate (nPCR) is a clinical indicator for evaluating the protein intake of patients undergoing dialysis. In a 2020 study, Hasegawa et al. reported that patients with an nPCR of < 1.0 exhibited higher frailty index values and mortality rates. The present study explored the effects of nutrition education on the dietary intake, nutrition-related indicators, nPCR, and 1-year survival rate of patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) with an nPCR of < 1.0. Beginning in late 2021, we conducted three comprehensive nutritional assessments and provided nutrition education (from February 2022) to patients undergoing routine HD or PD who had an nPCR of < 1.0; these patients were recruited from a medical center in northern Taiwan. The following presents the results. After completing nutrition education, the patients' protein intake increased significantly (HD, 1.03 ± 0.19 gm/kg of body weight to 1.10 ± 0.18 gm/kg of body weight, p = 0.001 [n = 49]); PD, 0.96 ± 0.16 gm/kg of body weight to 1.01 ± 0.17 gm/kg of body weight, p = 0.001 [n = 79]), and their serum phosphate levels improved significantly (HD, 4.84 ± 1.54 mg/dL to 4.42 ± 1.35 mg/dL, p = 0.021; PD, 5.54 ± 1.45 mg/dL to 5.19 ± 1.31 mg/dL, p = 0.003). After completing 1 month and, subsequently, 1 year of nutrition education, the patients experienced significant improvements in their nPCR (HD, baseline vs. 1 month vs. 1 year, 0.83 ± 0.15 vs. 0.98 ± 0.24 vs. 1.14 ± 0.29, p = 0.008; PD, baseline vs. 1 month vs. 1 year, 0.84 ± 0.10 vs. 0.91 ± 0.17 vs. 0.90 ± 0.16, p = 0.047). No significant difference in 1-year survival rates was identified between the nutrition intervention group (nPCR < 1.0) and nonintervention group (nPCR ≥ 1.0; intervention group vs. nonintervention group, 81.6% vs. 88.5%, p = 0.118). In conclusion, the protein intake and serum phosphate levels of the examined patients undergoing HD or PD improved after they received continual nutritional care. Their nPCR improved after they underwent 1 month of nutrition education, and this effect was maintained for 1 year. In this study, dieticians actively involved in nutrition education provided interdisciplinary nutrition care that improved the nutritional indicators of patients undergoing HD and PD.