以老年營養風險評估指標探討營養衛教改善血液透析新病患營養狀況之研究

Effects of Nutritional Education on the Nutritional Status of New Hemodialysis Patients Based on a Geriatric Nutritional Risk Index

周育鳳(Yu-Feng Chou) ； 吳文慈(Wen-Tzu Wu)

《台灣營養學會雜誌》 45卷3期 (2021/09) Pp. 98-110

https://doi.org/10.6691/NSJ.202109_45(3).0003

摘要

慢性腎臟衰竭病患者在透析治療前或進行血液透析後，因其飲食上的限制加上厭食，造成食物攝取下降，是發生蛋白質熱量耗損的高風險族群。本研究以回溯方式收集接受連續3次營養衛教之血液透析門診新病患共114位的病歷資料，依老年營養風險評估（geriatric nutritional risk index, GNRI）分組，探討營養衛教（每個月一次）對於血液透析新病患之飲食攝取和血液生化數值的影響。結果顯示高營養不良風險組及中度風險組的受試者（GNRI≦92）以老年人（≥65歲）為主，其營養攝取量與血液生化數值（血紅素、白蛋白、尿素氮和肌酸酐）顯著較低，在經過第一次的營養衛教後，即可顯著提升其熱量與蛋白質攝取量並可達到目標值的86%以上。此外，營養衛教可顯著改善整體受試者血紅素和白蛋白濃度，其中血清白蛋白濃度，相較於GNRI ＞ 98無營養不良風險組，營養衛教對GNRI ≦ 98的營養不良各組的改善效果尤其顯著，甚至可延續至追蹤期（第6個月）。因此，提供連續的營養衛教能夠提升有營養不良風險之血液透析新病患（尤其是老年患者）的飲食攝取量，進而改善其臨床血液生化指標，可預防透析後營養狀態惡化的發生。

關鍵字

老年營養風險評估 ； 營養衛教 ； 血液透析 ； 飲食攝取 ； 血清白蛋白 ； 血紅素

並列摘要

Dietary restrictions and anorexia in patients with chronic kidney disease either pre- or post-dialysis can lead to inadequate nutrient intake, which is one of the risk factors for protein-energy wasting. In this retrospective study, we collected medical records from 114 new hemodialysis patients who received nutritional education three times at one-month intervals. All patients were divided into four groups according to the score of the geriatric nutritional risk index (GNRI) at the baseline, and dietary intake and biochemical parameters were collected. Results showed that patients who were at high and moderate risk of malnutrition (with GNRI scores of ≦ 92) were mainly ≥ 65 years of age, and the dietary intake and blood biochemical data in these patients were significantly lower than those with GNRI scores of ＞98. After the first nutritional educational session, intake levels of calories and protein were significantly elevated in the group with GNRI scores of ≦ 92, and all subjects achieved 86% of the recommendations. In addition, hemoglobin and albumin significantly improved with an increased frequency of nutritional education in groups at high and moderate risk of malnutrition. Surprisingly, these effects were maintained during the follow-up period. Our study suggests that nutritional education can contribute to improving the dietary intake and biochemical parameters in new hemodialysis patients, especially the elderly, which may prevent them from experiencing malnutrition after dialysis therapy.

並列關鍵字

geriatric nutritional risk index ； nutritional education ； hemodialysis ； dietary intake ； albumin ； hemoglobin