營養衛教對高血磷透析病人的影響

Effects of Nutritional Education on Dialysis Patients with Hyperphosphatemia

欒家菁(Chia-Chin Luan) ； 賴玉釧(Yu-Chuan Lai) ； 王昱鈞(Yuh-Jiun Wang) ； 劉麗娟(Lie-Chuan Liu) ； 蔡萬全(Wan-Chuan Tsai)

《台灣營養學會雜誌》 42卷3期 (2018/09) Pp. 89-97

https://doi.org/10.6691/NSJ.201809_42(3).0002

摘要

血磷代謝異常是透析病人常見的併發症。除了血液透析與磷結合藥物外，限磷飲食在血磷控制上也扮演重要的影響角色。此研究個案為某醫學中心長期血液透析達六個月以上且平均三個月血磷值均大於5.5 mg/dL的30位病人，每兩週由營養師採一對一飲食衛教方式，教育介入期間16週，後續再追蹤8週。分析衛教後之KAP（Knowledge Attitude Practice test）分數，無論在知識、態度、行為及總分均有明顯進步（p ＜ 0.05）。衛教後個案血磷值顯著降低（p ＜ 0.001）。研究結束時個案血清白蛋白無明顯降低情形。本研究建議應持續對長期透析患者做營養教育，且積極導正個案高磷食物攝取的情形，以助於飲食行為改變及血磷的改善，並維持良好營養狀況。

關鍵字

飲食行為 ； 衛教 ； 透析病人 ； 飲食-態度-行為 ； 高血磷

並列摘要

Metabolic disorders of phosphorus are a common complication in dialysis patients. In addition to hemodialysis and phosphorus-binding drugs, dietary phosphorus restrictions also play an important role in serum phosphorus control. We analyzed the distribution of serum phosphorus and Knowledge Attitude Practice (KAP) test scores in 30 patients on hemodialysis who had been receiving hemodialysis for at least 6 months and who had average plasma phosphorus values of ＞ 5.5 mg/dL in most recent 3 months. All cases in this study had been educated one-on-one by a dietitian once every 2 weeks during 16 weeks of the intervention period, and all patients were followed up 8 weeks later. The knowledge, attitudes, behaviors, and total scores of the KAP test significantly improved (p ＜0.05). Serum phosphorus levels were significantly lower at the end of the 16-week intervention and at 8 weeks later compared to before the intervention (p ＜0.001). Serum albumin showed no significant difference at the baseline, at the end of the 16-week intervention, and at 8 weeks later. The results suggested that a dietitian should conduct nutritional education programs for long-term dialysis patients, and cases should be guided to avoid the intake of high-phosphorus foods to maintain better dietary behaviors, good serum phosphorus control, and a good nutritional status.

並列關鍵字

dietary behavior ； education ； dialysis patients ； knowledge, attitude, and practice ； hyperphosphatemia