- 學位論文
台灣漢生病患口腔健康與營養狀況之研究
Research on Oral Health and Nutritional Status of Patients with Hansen's Disease in Taiwan
摘要
本研究旨在經由問卷及住民血液、口腔黏膜組織唾液以瞭解台灣漢生院民營養狀況與口腔念珠菌感染情形，並與前期所得之口腔健康狀況資料分析，儘早發現漢生院民潛在之營養狀況問題，並為做照護介入計畫提供良好之依據。 為達到此目的，本研究方法採橫斷面調查法，立意取樣上期研究之衛生福利部樂生療養院醫療大樓住民97人，以SGA評估其營養狀況，結合多重性藥物使用調查問卷為研究工具，收集人體數據、血液檢測、生化檢測、口腔念珠菌檢測資料。資料收集以Excel建檔，並採用SPSS 15.0版套裝軟體進行資料分析，樣本為常態分佈的狀況下，使用方法包括：描述性統計、單因數變異數分析、卡方分析、spearman等級相關係數分析及多變相迴歸分析。 根據研究結果歸納以下結論： 一、人口學特性 調查對象男女人數相當(男：54、女：43)，年齡70 ~ 80歲者居多(34/97)，漢生病患以不抽煙者多於抽煙者(83/97)。 二、口腔狀況 療養院漢生病老人之口腔狀況 (齒列、牙周、咬合) 情形均表現較差，缺牙補牙和牙結石狀況嚴重。口腔白色念珠菌培養結果以陽性結果居多，達七成以上(69/97)。多重藥物使用時間越久白色念珠菌檢驗呈陽性結果的可能越高。牙周、咬合情況越糟糕白色念珠菌檢驗呈陽性的可能性越高。 三、營養狀況 SGA等級以B級人數最多。 透過研究發現，樣本TSF三頭肌皮褶厚度男性(mean=15.802± 6.0603)、女性(mean=20.472±6.9762) 平均值均大於男性(mean=12.5)、女性 (mean=16.5) 理想值。MAMC上臂肌圍男性 (mean=20.093±3.2666)、女性 (mean=19.657±3.2123) 平均值均小於男性(mean=24.8) 、女性 (mean=23.2) 理想值。BMI男性(mean=21.811±3.2116)、女性 (mean=22.878±5.1070) 皆屬正常範圍( 18.5 ~ 24)。 而HB血色素男性 (mean=12.919±1.7617) 低於正常水準 ( 13.2 ~ 17.2)，女性 (mean=11.677±1.6594) 則屬正常範圍 (10.8 ~ 14.9)。ALB白蛋白男性 (mean=4.033±0.4313)、女性 (mean=4.049±0.4558) 皆屬正常範圍 ( 3.5 ~ 5)。女性TSF三頭肌皮褶厚度顯著大於男性，男性HB血色素顯著大於女性。 60歲以下的受訪者營養狀況更佳。抽煙者的血色素和身高大於不抽煙者，這可能是由於抽煙者多為男性，而以上兩個指標在性別上本身就有顯著差異。因此認為抽煙不是影響營養狀況的因素。 年齡會影響SGA。口腔白色念珠菌培養結果為陰性的受訪者的營養狀況更佳。
並列摘要
The purpose of the study was to understand the nutrition and oral candidiasis cases of people in Taiwan Hansen hospital. Combining with previous oral health information data, the study hoped to find potential issues for the nutrition statues in Hansen hospital so as to provide a good basis for care intervention program. In order to realize the purpose, the study adopted a cross-sectional survey and conducted a purposive sample on 97 residents in Losheng Sanatorium and Hospital, Ministry of Health and Wealth, and accessed their SGA nutritional status. With multiple drug uses questionnaire as research tool, the study collected respondents’ body data, blood test, biochemical detection and oral candidiasis inspection data. The statistics analysis methods used in the study included descriptive statistics, one-way ANOVA, chi-square analysis, Spearman's rank correlation coefficient and multiple linear regression analysis with SPSS 18.0 statistical software. The study analyzed and summarized results as follows: First, the demographic characteristics: Roughly the same number of male and female respondents(male：54、female：43); mostly aged 70 to 80(34/97); more non-smokers(83/97). Second, the oral condition: Their oral condition (dentition, periodontal, occlusal) was generally poor, missing or fillings teeth and serious dental calculus condition. The oral culture of Candida albicans showed a lot of positive results, over 70%(69/97).A long time of multiple drug users may have a higher rate of Candida albicans positive result.Poor periodontal and occlusal condition may a higher rate of Candida albicans positive result. Third, the nutritional status: Most of them were B in SGA rating. The study results found that sample triceps skinfold thickness (TSF) of males (mean=15.802± 6.0603) and women (mean=20.472±6.9762) were greater than the average ideal value of male (mean = 12.5) and women (mean = 16.5). The arm muscle circumference (MAMC) of Men (mean=20.093±3.2666) and women (mean=19.657±3.2123) were less than the average ideal value of male (mean = 24.8) and women (mean = 23.2). BMI of male (mean=21.811±3.2116) and women (mean=22.878±5.1070) were winthin the normal range( 18.5 ~ 24). The male HB (mean=12.919±1.7617) was lower than the normal level (13.2 - 17.2), women’s (mean=11.677±1.6594) were normal (10.8 to 14.9). ALB of male (mean=4.033±0.4313) and women (mean=4.049±0.4558) were within normal range (3.5 to 5). Women TSF was significantly larger than the male’s, while male HB was significantly larger than female’s. Nutritional status of respondents under 60 years old was better. Smoker hemoglobin was greater than a non-smoker, so as the height indicator, this may be due to sex features as they two factors were originally affected by sex. Therefore it is believed that smoking is not a nutrition affecting factor. Age can affect SGA. Respondents with negative result in oral Candida albicans culture results showed a better nutritional status.