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長期血液透析病人食慾評估與營養狀態的探討
Investigation of the Nutritional Status and Appetite Assessments in Maintenance Hemodialysis Patients
摘要
背景：長期透析病人有高比率的營養不良，其原因可能味覺失調、腸胃蠕動異常、憂鬱等。研究目地：探討南台灣某醫院血液透析病人影響食慾的相關營養狀態。材料與方法：本研究以國立成功大學附設醫院78位血液透析病人為研究對象，收案時間由105年3月至11月，採用7分制的主觀整體營養評估、測量握力強度、採用8題40分的食慾評估問卷，每題1～5分，1分最差，5分最好。結果：由食慾自我評估分數中，有食慾不好風險的病人有32位（占41%）。食慾好比食慾不好的病人顯著有較強的握力（22.6 ± 10.2 vs. 18.1 ± 5.5 kg, p ＜0.05）及較高分的主觀整體營養評估（營養較好）（5.4 ± 0.7 vs. 5.0 ± 1.0 points, p ＜0.05），8題的食慾評估中以飢餓程度（3.4 ± 0.9 vs. 2.2 ± 0.7 points, p ＜0.0001）、味覺變化（3.3 ± 0.6 vs. 2.9 ± 0.5 points, p ＜0.0005）、情緒（憂鬱）狀況（3.3 ± 0.8 vs. 2.9 ± 0.5 points, p ＜0.01）等，皆以食慾好的病人比食慾不好的病人顯著有較高的分數。結論：經本研究發現血液透析病人具有食慾不良之高風險，且無飢餓感、味覺變差及憂鬱等現象，這些都會影響病人的營養狀態及預後，未來對這些高風險的病人應積極的營養諮詢與介入，甚至轉介心理治療師或精神科醫師來改善其憂鬱的風險。
並列摘要
Background: Maintenance dialysis patients have a high rate of malnutrition; the causes may were taste disorders, abnormal gastrointestinal motility, and depression. The aim of this study was to investigate factors that affect the appetite and nutritional status of hemodialysis patients in southern Taiwan. Materials and methods: In this study, 78 hemodialysis patients were enrolled at National Cheng Kung University Hospital, and the trial from March to November 2016. We used a 7- point subjective global assessment (SGA) score, measured hand grip strength (HGS), and used an appetite assessment, that included eight questions and totaled 40 points. Results: Thirty-two patients (41%) had a risk of a poor appetite from the appetite assessment. Patients with a good appetite had a significantly higher HGS (22.6 ± 10.2 vs. 18.1 ± 5.5 kg, p ＜0.05) and SGA scores (5.4 ± 0.7 vs. 5.0 ± 1.0 points, p ＜ 0.05) than patients with poor appetite risk. In the eight questions of the appetite assessment, patients with a good appetite had significantly higher scores than patients with a poor appetite for hunger (3.4 ± 0.9 vs. 2.2 ± 0.7 points, p ＜0.0001), change in taste (3.3 ± 0.6 vs. 2.9 ± 0.5 points, p ＜ 0.0005), and mood (depression)(3.3 ± 0.8 vs. 2.9 ± 0.5 points, p ＜0.01). Conclusions: Our study found that hemodialysis patients have a high rate of poor appetite symptoms such as a high risk of no hunger, poor taste, and depression. In the future, we suggest nutritional consultations and interventions for patients at risk for a poor appetite, and transfer to physicians to ameliorate the risk of depression.