透析靜脈營養的補充對營養不良的洗腎病患之功效

慢性腎臟功能衰竭患者（End-Stage of Renal Disease, ESRD）因體內水份、鹽份及尿毒素的堆積，需要實施每週三次、每次四小時的血液透析治療（Hemodialysis）。但血液透析患者又常面臨營養不良（Malnutrition）之情況，此時病患的體重，或血清中的白蛋白（Serum albumin）濃度通常較低，故本研究欲探討於營養不良的洗腎患者在每次血液透析時給予透析靜脈營養液（Intradialytic parenteral nutrition, IDPN），共為期2個月，對受試者身體質量指數（Body mass index, BMI）、主觀整體營養評估指數（Subjective global assessment score, SGA score）、血清白蛋白（Serum albumin），及生活品質（Quility life）的影響。本研究採取隨機分組試驗。受試者為嘉義市聖馬爾定醫院30-85歲，已接受三個月以上之血液透析患者共28名，其中男性8名，女性20名。受試者隨機分成兩組，實驗組於每次血液透析時接受含有葡萄糖100公克、胺基酸34公克、脂肪40公克，總熱量936大卡之1026毫升之靜脈營養液，連續2個月，每週3次的透析靜脈營養液。而控制組則維持平日飲食，不介入任何的營養治療。在實驗開始前以及第2個月實驗結束後各收集一次數據。結果顯示，經過2個月的IDPN營養治療，身體質量指數與血清白蛋白數值雖然無明顯的增加，但是有上升的趨勢。而主觀營養評估分數（SGA score）則有明顯的進步。另外，使用簡表36（Short Form-36, SF-36）評估IDPN的營養介入在改善病患生活品質方面，在「一般健康」此項有明顯的改善。

關鍵字

慢性腎臟功能衰竭；血液透析；營養不良；透析靜脈營養；身體質量指數；主觀整體營養評估；血清白蛋白；生活品質；簡表-36

並列摘要

The end-stage of renal disease (ESRD) patient needs three times hemodialysis (HD) treatment per week because they have fluid, salt and urea accumulation in body. When hemodialysis patient has malnutrition condition, usually has low dry body weight or lower serum albumin levels. This study wants to know if we continue give malnutrition HD patient the intradialytic parenteral nutrition (IDPN) for 2 months, the efficacy to body mass index (BMI), subjective global assessment score (SGA), serum albumin level and quality of life. This study is designed as randomized trial. Twenty-eight HD subjects that they have already received more 3 months hemodialytic treatment and also with malnutrition in St. Martin De Porres hospital in Chayi, 8 men and 20 women aged 30 to 85 years volunteered to participate. The subjects were randomized to two groups. Study group received 3 times per week, continue 2 months IDPN supplement. The IDPN include glucose 100 g, amino acids 34 g, fat 40g and 936 calories. Control group did not change their dietary habit and neither any nutritional intervention during study period. We collect the data on the beginning and 2 months. The results showed after 2 months IDPN nutritional supplement, although the BMI and serum albumin concentration was not significantly increase but they have trend to rise. The SGA score have significant improvement. In addition, we evaluate the quality of life by using the Short Form-36, the result is significant improvement in General Health score.

並列關鍵字

Hemodialysis ； Malnutrition ； Intradialytic Parenteral Nutrition ； Body mass index ； Subjective global assessment ； Serum albumin ； quality of life ； Short Form-36

參考文獻

行政院衛生署國民健康局。民國95年慢性腎臟病防治手冊。

main factor in morbidity and mortality of hemodialysis patients.

Kidney Int Suppl. 16:199-203

Effects of intradialytic parenteral nutrition in chronic haemodialysis

Bossola M, Muscaritoli M, Tazza L, Giungi S, Tortorelli A, Fanelli FR, Luciani G. (2005) Malnutrition in hemodialysis patients: what therapy? Am J Kidney Dis. 46:371-386

國際替代計量

透析靜脈營養的補充對營養不良的洗腎病患之功效

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