亞急性呼吸照護病房病人足夠熱量攝取與脫離呼吸器相關性之探討

Relationship between Adequate Energy Intake and Successful Weaning of Patient in Respiratory Care Center (RCC)

吳采錦(Tsai-jiin Wu) ； 陳梅恩(Mei-En Chen) ； 陳淑惠(Sue-Hui Chen) ； 朱璧岑(Pi-Chen Chu) ； 吳玉茹(Yu-Ju Wu)

《臺灣膳食營養學雜誌》 8卷1期 (2016/06) Pp. 25-32

https://doi.org/10.6709/TJD.2016.0801.03

摘要

亞急性呼吸照護病房（Respiratory care center, RCC）為一中重度加護病房單位，當病人於重症加護病房使用呼吸器滿21天病情趨於穩定時，會轉入RCC進行呼吸器脫離訓練，以提高病人脫離呼吸器的機率。但亞洲地區針對RCC病人的營養攝取狀況與成功脫離呼吸器的相關研究較少，本研究目的為探討RCC病人熱量攝取足夠與否與成功脫離呼吸器的相關性。本研究為回溯性研究，針對2005至2007年於南部某醫學中心RCC病房，接受腸道灌食且有營養照護之個案為研究對象（n = 477），納入分析條件為使用呼吸器及飲食紀錄完整之病人。研究中將病人熱量攝取足夠性，依達到營養師建議量＜ 50%、達到50-79%及≥ 80%之百分比分成熱量攝取不足、適中和足夠三組。單變量分析顯示，血清白蛋白濃度（albumin）隨著熱量攝取的足夠性呈線性且顯著之增加（p ＜ 0.05）。在調整干擾因子（年齡、性別、身體質量指數、住院天數、灌食天數及疾病診斷），相較於熱量攝取不足組之病人，攝取適中組（OR: 0.144; 95% CI: 0.036-0.584; p = 0.006）及攝取足夠組（OR: 0.120; 95% CI: 0.031-0.459; p = 0.002），無法脫離呼吸器之風險性低。故熱量攝取足夠可能為脫離呼吸器之重要因子，因此，對亞急性呼吸照護病房病人應進行積極營養介入，對其臨床疾病治療進展可能有益。

關鍵字

亞急性呼吸照護病房 ； 脫離呼吸器 ； 熱量攝取

並列摘要

Respiratory care center (RCC) is an intensive care unit. The intubated patients with ventilator support for more than 21 days will be transferred to RCC for enhancing weaning rate. The studies related to nutritional status and would successful rate of weaning ventilator in the RCC patients are less reported in Asian populations. This study aim of the study was to examine weather adequate energy intake correlate with successful ventilator weaning in RCC patients .It is a retrospective study at a medical center in southern Taiwan, from 2005 to 2007 (n = 477). The RCC patients who had complete diet record and successful ventilator weaning were included in this analysis. Energy intake was defined as a mean daily intake recommendation levels at ＜ 50%, 50-79%, and ≥ 80% as inadequate, medium divided by and adequate groups. Univariate analysis showed that serum albumin concentration has a linear correlation with three energy groups and increase significantly (p ＜ 0.05). After adjusting the confounder factors (age, gender, body mass index, length of stay, feeding day and disease diagnosis), the patients in the medium (OR = 0.144; 95% CI = 0.036-0.584; P = 0.006) and adequate energy intake group (OR = 0.120; 95% CI = 0.031-0.459; P = 0.002) had lower risks of unsuccessful weaning compared to the low energy intake group. Therefore, adequate energy intake appears to be an important factor in the success of ventilator weaning in the RCC patients. Nutrition support is beneficial for the RCC patients and should be intervened aggressively.

並列關鍵字

respiratory care center ； energy intake ； ventilator weaning