探討長期血液透析影響營養狀態與相關因素結果分析

Investigate the impact of long-term hemodialysis nutritional status and the results of analysis of factors

李宜樺(Yi-Hua Lee)

指導教授 ： 陳宏一

長榮大學/健康科學學院/醫學研究所/碩士(2015年)

https://doi.org/10.6833/CJCU.2015.00041

摘要

長期血液透析患者約有18-70％有蛋白質熱量營養不良問題，而老年透析患者營養不良的比例更高，與預測患者罹病率及死亡率呈正相關性。本研究目的乃在探討長期血液透析患者，在營養師尚未介入營養治療前之營養狀態與預後相關因素分析，其研究對象是以台灣地區南部某地區教學醫院血液透析室，以長期接受血液透析患者為對象，採用回溯性研究設計，將研究個案資料來自於臨床病歷資料及相關檢驗評估報告。本研究樣本之個案數總共有113位，依變項分為年齡、身體質量指數與營養狀況共三項進行統計分析，評估患者透析照護品質、靜脈輸入紀錄及臨床生化檢驗值之數據之顯著性差異性。結果顯示樣本平均年齡65±10.7歲，以65歲以下(52.2％)居多；教育程度以高中以上(58.4％)居多；平均洗腎年資大於3年以上者居多(44.2％)。透析照護品質方面，皆達到DOQI準則要求的標準。再者，樣本個案數其Hct數值有高達74.3%，尚未達到DOQI準則的目標值( 33-36% )，且有超過99.1%的病人在使用EPO針劑，年度平均值為109.6±47.3次，表示研究樣本個案數的病人有明顯貧血情形。至於鈣磷乘積比，其各年齡平均值44.1±13.5 mg2/dL2 。然而，樣本個案數白蛋白年初平均值為3.4±0.4g/dl，尚未接近4.0 g/dl 的目標，表示研究樣本個案數病人的營養狀態不佳。總結此研究結果，其統計上雖呈現顯著性差異(P＜0.05)，如:透析指標、白蛋白及血容比數值，但只能做簡單及單一性評估參考，故結果不完全代表所有血液透析患者之營養狀態。
2000年美國國家腎臟基金會(National Kidney Foundation, NKF) 提出K/DOQI(Kidney Disease Outcomes Quality Initiative)(Kopple,2001)營養臨床實用指引，沒有所謂的單一營養檢測指標能夠全部表現出蛋白質熱量營養狀態，因臨床各項評估方法有其使用之意義及限制性，故需考慮各方面資料、測量、分析與探討，收集營養檢測指標越多，其評估營養狀態準確度、敏感度、專一度相對提昇，如此才能得到較客觀的評估結果。

關鍵字

血液透析 ； 慢性腎臟功能衰竭 ； 蛋白質熱量營養不良

並列摘要

Long-term hemodialysis patients, about 18-70% of protein-energy malnutrition, and a higher proportion of elderly dialysis patients with malnutrition, morbidity and mortality in patients with predicted positive correlation. The purpose of this study is to explore the long-term hemodialysis patients, nutritional status and prognostic factors of nutrition therapy before interventional dietitian yet, its object of study is a region in southern Taiwan teaching hospital hemodialysis, in order to receive long-term hemodialysis patients as an object, using retrospective study design, clinical case study data from medical records and related testing and evaluation reports. The number of cases of the total study sample of 113, the dependent variable is divided into age, body mass index and nutritional status were analyzed a total of three to assess the quality of care of dialysis patients, the infusion of significant data records and clinical biochemistry values difference. The results showed that samples 65 ± 10.7 years average age, 65 years of age (52.2%) the majority; education with a high school (58.4%) the majority; seniority is greater than the average dialysis for more than three years by the majority (44.2%). Dialysis care of quality, are up to the standard required by DOQI guidelines. Furthermore, the number of sample cases it Hct value up to 74.3 percent, has not yet reached the target DOQI guidelines (33-36%), and patients with more than 99.1 percent in the use of EPO injection, an annual average of 109.6 ± 47.3 times, showing patient study sample number of cases of anemia are obvious situations. However, the number of cases in early albumin sample average of 3.4 ± 0.4g / dl, yet close to the 4.0 g / dl target, indicating poor nutritional status of patients in the study sample number of cases. Summarizes the results of this study, although it is statistically presented statistical significance (P ＜0.05), such as: dialysis index, albumin and hematocrit values, but can only do simple and the unity of the assessment and therefore the results are not fully representative of all blood Dialysis patient's nutritional status.
2000 US National Kidney Foundation (National Kidney Foundation, NKF) proposed K / DOQI (Kidney Disease Outcomes Quality Initiative) (Kopple, 2001) Clinical Nutrition practical guidelines, there is no so-called single nutrient can detect all indicators showed protein-energy nutritional status , because the clinical significance of the assessment methods and limiting their use of, and therefore need to consider data measurement, analysis and discussion of all aspects of Collecting Nutrition Examination index more accurate its assessment of nutritional status, sensitivity, specificity of relative improvement, so in order to get a more objective assessment.

並列關鍵字

hemodialysis ； chronic renal failure ； protein-energy malnutrition

參考文獻

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