營養教育介入對血液透析病患熱量及蛋白質營養狀況的改善

蛋白質熱量營養不良（protein-energy malnutrition, PEM）是長期透析患者最常見的營養問題，且與長期血液透析患者的發病率及死亡率之增加具有強烈的相關性。本研究在探討對於營養不良的血液透析患者給予3個月營養教育課程之後，其熱量與蛋白質營養不良的改善情形。研究對象來自北部某教學醫院門診之血液透析患者共18位，使用血液透析營養手冊給予一對一營養教育，介入期間為期3個月，第1個月進行血液透析飲食衛教，著重在學習攝取足夠熱量及蛋白質；第2個月強調低磷、低鉀飲食原則；第3個月為控制水分攝取技巧。本研究受試者平均年齡為67.7 ± 10.4歲、身高163.1 ± 7.4公分、body mass index（BMI）23.1± 3.4 kg/m^2；血液生化值方面，營養教育前白蛋白3.5 ± 0.4 g/dL、血鉀4.7 ± 0.9 mmol/L、血磷4.0 ± 1.0 mg/dL；三個月營養介入後白蛋白顯著上升至3.8 ± 0.2g/dL（p ＜ 0.001），血鉀4.8 ± 0.7 mmol/L，沒有顯著差異（p = 0.387），而血磷亦顯著上升5.0 ± 1.5 mg/dL（p = 0.010）。血鉀異常（＞ 5.5 mmol/L）之百分比在營養介入前為22.2 %，在3個月營養介入後則下降11.1%，但無統計差異（p = 0.414）。血磷異常（＞ 5.5 mg/dL）之百分比在營養教育前為16.7%，而3個月營養教育後上升至 38.9%（p = 0.103）。本研究受試者在3個月營養教育後，營養狀況有顯著的改善，白蛋白有顯著增加。但血磷控制不理想，未來需加強洗腎患者高血磷飲食衛教。

關鍵字

血液透析；蛋白質熱量營養不良；營養教育

並列摘要

Protein-energy malnutrition (PEM) is common in patients on long-term hemodialysis, and it is strongly associated with increased morbidity and mortality. This study evaluated the improvement of PEM and the effectiveness of nutritional education in patients on hemodialysis. This study was conducted on 18 patients on hemodialysis from a teaching hospital in northern Taiwan for 3 months. The patients received nutritional education in one-on-one sessions each month by using the Diet and Dialysis booklet. In the first month, the patients were provided with instructions on how to achieve sufficient calorie and protein intake. In the second month, they received education on the importance of a low-phosphorus and low-potassium diet. In the third month, they were provided with tips on limiting fluid intake. The continuous data of 18 patients on hemodialysis are expressed as means ± standard deviations. The average age was 67.7 ± 10.4 years; the average height was 163.1 ± 7.4 cm; and the average body mass index was 23.1 ± 3.4 kg/m^2. The variables were compared before and after 3-month nutritional interventions. Serum albumin was significantly increased (3.5 ± 0.4 vs. 3.8 ± 0.2 g/dL, p ＜ 0.001); no significant differences were noted in serum potassium (4.7 ± 0.9 vs. 4.8 ± 0.7 mmol/L, p = 0.387); and serum phosphate was significantly increased (4.0 ± 1.0 vs. 5.0 ± 1.5 mg/dL, p = 0.010). The proportion of the subjects with abnormal serum potassium level (＞ 5.5 mmol/L) decreased from 22.2 % to 11.1 % after the interventions, but the difference was nonsignificant. The proportion of the subjects with abnormal serum phosphate level (＞ 5.5 mg/dL) increased from 16.7 % to 38.9 % (p = 0.103). In conclusion, after the 3-month nutritional intervention, serum albumin significantly increased, but serum phosphate levels were not controlled adequately. We plan to research how to improve educational interventions for the dietary management of hyperphosphatemia in patients on hemodialysis.

並列關鍵字

hemodialysis ； protein-energy malnutrition (PEM) ； nutritional education

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