- 期刊
評估某地區教學醫院透析病人接受營養照護介入後之短式簡易營養評估量表改變成效
Assessment of the Effectiveness on the MNA-SF of Dialysis Patients' Nutritional Care Interventions in a Regional Teaching Hospital
摘要
臺灣每年透析人數約6～7萬人，金門地區罹患慢性腎臟病總人數逐年增加，透析新病人發生率亦逐年增加，而目前尚未有該地區營養照護介入之相關研究。故本研究為回溯性資料收集，目的為評估某地區教學醫院透析病人營養照護介入之成效。本研究以金門醫院血液透析室透析之病人為對象。運用短式簡易營養評估量表（Mini-Nutritional Assessment-Short Form, MNA-SF）及National Kidney Foundation Kidney Disease Outcomes Quality Initiative（NKF-K/DOQI）建議的測量項目（血清白蛋白、血清膽固醇、血清尿素氮、血清肌酸酐、血清鉀及血清磷）評估透析病人之營養狀況。下列生化值（血清白蛋白＜ 4.0 g/dL、膽固醇濃度＜ 150 mg/dL、輸鐵蛋白濃度＜ 200 mg/dL、透析前blood urea nitrogen [BUN] ＜ 50 ~ 80 mg/dL、透析前血清肌酸肝＜ 10 mg/dL、透析前血清鉀過低／高、透析前血磷值過低／高）≥ 4項為營養不良高危險初步篩檢結果或病人及家屬需求，即照會營養師完成單次營養會診，共計篩選出41名個案。本研究為2016年12月起至2017年6月間完成MNA-SF評估2次之個案，期間營養師有收到會診單後，一對一給予病人或家屬實施個別化營養諮詢，並完成單次會診回覆者，作為介入營養照護組；其餘個案為無介入組。分析介入營養照護組與無介入組，兩組分別在生化值及MNA-SF分數於前後2次評估之差異。收集資料利用成對樣本t檢定（paired sample t-test）分析各組病人之前後差異。結果顯示兩組之生化值前後2次評估皆無差異性；但以MNA-SF分數方面，無介入組無差異性，分析介入營養照護組在初次評估（介入前）平均分數為11.8 ± 2.3分、第二次評估（介入後）平均分數為12.7 ± 1.7分（p = 0.002），在統計學上有顯著的意義。雖然非所有測量項目可達到預期結果，但在接受一次營養諮詢會診的病人其MNA-SF平均分數是有增加。故整體而言，血液透析單位病人之營養師進行單次諮詢之介入成效仍有所不足，營養介入之模式及頻率尚待建立。
並列摘要
The number of dialysis patients in Taiwan is about 60000-70000 per year. The total number of chronic kidney diseases in Kinmen has increased year by year, and the incidence of new dialysis patients has year by year. At present, there is no research to examine effect of nutrition care intervention in the region. This study is a retrospective analysis and its purpose is to evaluate the effectiveness of nutritional care interventions dialysis patients in a regional teaching hospitals of Kinmen Hospital. Based on Mini-Nutritional Assessment- Short Form (MNA-SF) and National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI), measurement items including serum albumin ＜ 4.0 g/dL, cholesterol concentration ＜ 150 mg/dL, transferring concentration ＜ 200 mg/dL, blood urea nitrogen [BUN] ＜ 50-80 mg/dL before dialysis, serum creatinine liver ＜ 10 mg/dL before dialysis, serum potassium level is too low/high before dialysis, blood phosphorus value is too low/high before dialysis were used to evaluate the nutritional status in dialysis patients. If the suboptimal biochemical values were ≥ 4 items, the information served as the preliminary screening results of high risk of malnutrition or the needs of patients and their families to receive consultation by a dietitian. A total of 41 cases were screened. This study retrieved from the cases of completing the MNA-SF assessment twice from December 2016 to June 2017. After the dietitian receiving the consultation forms, the individualized nutrition consultation was given to the patients or family members one by one, and consultation completed for the interventional nutrition care group for only onetime; the remaining cases were non-intervention groups. The interventional nutrition care group and the non-intervention group were analyzed. The biochemical values and MNASF scores were evaluated before and after the two groups. Paired t-test was used to analyze the differences before and after the consultation. There was no difference in the biochemical values before and after nutrition consultation within each group. However, in terms of MNA SF scores, there was no difference in the non-intervention group. The average score of the interventional nutrition care group in the initial evaluation was 11.8 ± 2.3 and was 12.7 ± 1.7 (p = 0.002) after evaluation. Although not all measurement items achieved the expected results, the average MNA-SF score was increased in patients who received a nutritional consultation. Thus, the effectiveness of a single-time nutritional consultation by dietitian in patient receiving dialysis is still uncertain, and the model and frequencies of nutritional intervention have yet to be established.