中部某地區醫院之長照機構住院病人蛋白質-熱量攝取對營養狀況及臨床預後相關性之探討：病例回溯性研究

The relationship of protein-energy intake, nutritional status, and clinical outcomes in inpatients from long-term care institutions: a retrospective study from a regional hospital in Taichung

林宜德(Yi-De Lin)

指導教授 ： 林娉婷

中山醫學大學/健康管理學院/國際健康產業經營管理碩士在職專班/碩士(2022年)

https://doi.org/10.6834/csmu202200008

摘要

營養不良在長期照護機構是最常見的問題，營養不良會造成跌倒、壓力性損傷、術後感染率增加、延長住院天數及增加醫療照護費用。本研究目的為以長照機構住院病人為對象，探討其飲食熱量及蛋白質攝取與營養狀況及臨床預後之相關性。本研究設計利用回溯性分析2018至2020年間中部某地區醫院病歷資料，共納入251位由長照機構入院、住院日期大於七天、年齡介於50-85歲且接受腸道營養並有營養照護及完整飲食紀錄之住院病人。資料收集包含基本資料、血液生化檢驗值、飲食攝取情形、營養狀態評估、住院天數及死亡率。結果顯示，本機構研究對象之血清白蛋白（中位數3.4公克/分升）及血紅素濃度（中位數：男11.6公克/分升；女11.0公克/分升）較低於正常值，而發炎指數（高敏感C-反應蛋白濃度，中位數4.4毫克/分升）有偏高的情形。另有近六成的研究對象有白蛋白營養不良之情形。依進食方式分組發現，管灌餐相較於口服餐在入院時有較低之身體質量指數（p = 0.02）與較高的臥床比例（p < 0.01）。在血液生化值方面，管灌餐者相較於口服餐者有較低之空腹血糖（p = 0.03）、糖化血色素（p < 0.01）及血清肌酸酐（p < 0.01）濃度並有較高的腎絲球過濾率（p < 0.01）與白血球數量（p < 0.05）。另管灌餐者於入院後之熱量及蛋白質攝取顯著高於使用口服餐者（p < 0.01）。以建議攝取量進一步分析發現，當管灌餐之熱量攝取量未達建議量時，其住院死亡率比口服餐者有顯著較高之情形（p = 0.03）。由以上結果推論，我們建議長照機構者住院病人，尤其是管灌食者，應例行監測其熱量及蛋白質攝取是否足夠，以避免不佳之臨床預後。

關鍵字

蛋白質-熱量攝取 ； 營養狀況 ； 臨床預後 ； 住院病人 ； 長照機構

並列摘要

Malnutrition is a major problem in long-term care institutions and it may increase the risk of falls, pressure injuries, postoperative infection, and prolonged hospital stays, causing a medical burden. The purpose of this study was to investigate the relationship of protein-energy intake, nutritional status, and clinical outcomes in long-term care institutions inpatients. This study was designed as a retrospective study. We analyzed the data from the medical records of a district hospital in Taichung from 2018 to 2020. A total of 251 patients aged between 50 - 85 were hospitalized for more than seven days. All inpatients were received enteral nutrition and had complete records for nutritional assessment and dietary records. The demographic and hematologic data, dietary intake, nutritional assessment, length of hospital stay, and mortality were collected in this study. The results showed that the median levels of serum albumin (3.4 g/dL) and hemoglobin (Hb, male, 11.6 g/dL; female, 11.0 g/dL) were lower than the normal values, and the median levels of the inflammatory marker (C-reactive protein, 4.4 mg/dL) was higher than the normal value. In addition, nearly 60% of the patients with a lower albumin level. After stratifying by the types of feeding, we found that patients with tube feeding had lower values of body mass index (p = 0.02) and a higher rate of bedridden (p <0.01) than those with oral feeding. Regarding hematologic data, patients with tube feeding group had lower values of fasting glucose (p = 0.03), glycated hemoglobin (HbA1c, p < 0.01) and serum creatinine (p < 0.01), but higher values of estimated glomerular filtration rate (eGFR, p < 0.01) and white blood cells (p < 0.05) than the oral feeding group. Moreover, the patients with tube feeding had a significantly higher energy and protein intake than the oral feeding group (p < 0.01); however, significantly higher mortality was found in the tube feeding group if they did not reach the recommendation of energy intake (p = 0.03). In summary, we suggested that patients in long-term care institutions should regularly monitor their energy and protein intake to avoid poor clinical outcomes, especially for patients with tube feeding.

並列關鍵字

protein-energy intake ； nutritional status ； clinical outcomes ； inpatients ； long-term care institutions

參考文獻

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一、中文部分

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