營養介入對急性心衰竭病人之營養狀況、生活品質及死亡率探討

Nutritional Intervention on Nutritional Status, Quality of Life and Mortality in Patients with Acute Heart Failure

吳麗紅(Li-Hung Wu)

指導教授 ： 潘怡如

義守大學/醫學院/護理學系/碩士(2023年)

摘要

背景: 心臟衰竭為進行性的症候群，心臟無法供應血液到身體各器官，使血管收縮阻力增加造成心臟負荷，加速其代償失調。急性心臟衰竭中營養不良風險評估居高，而營養不足亦可造成低心輸出量間歇影響心臟收縮力降低，最終使多重器官灌流不足無法維持功能，長久亦影響病人營養狀況及生活品質逐漸變差，甚至死亡率增加。
目的: 本研究在了解營養介入對心衰竭病人之營養狀況、生活品質及死亡率之間的相關性。
方法：本研究採二組前、後測的類實驗性研究設計(quasi-experimental design) 以縱貫性追蹤，方便取樣方法(convenience sampling)，以南部某教學醫院心臟科病房，住院中急性心衰竭病人共73位為研究對象，採用營養介入措施方式並隨機取樣的研究設計，將參與者分配成兩組，實驗組除了給予一般疾病衛教，並額外給予營養介入衛教（n = 40），對照組只接受一般疾病衛教（n = 33）。兩組皆使用營養篩選表(Nutritional Risk Screening )，實驗組給予營養介入的配方牛奶飲品，分別在入院、出院後一週及回診5次共追蹤12個月，給予衛教後並填寫營養風險指數(geriatric nutritional risk index (GNRI)、生活品質量表(Minnesota Living with Heart Failure Questionnaire)及死亡率預測表(Meta-Analysis Global Group in Chronic Heart Failure ;MAGGIC Risk )，病人於入院時 (T0）執行前測，住院期間持續給予營養介入措施及衛教後並填寫問卷後，出院再次進行相關諮詢及衛教指導，在出院後一週回診(T1)、第一個月(T2)、第三個月(T3)、第六個月(T4)、第九個月(T5)及第十二個月(T6)皆進行後測。
結果：實驗組予以營養介入措施後，由廣義估計方程式進行對心衰竭病人的成效分析，分析結果顯示白蛋白在T6 (β=0.434, P<.05)，心跳在T5(β=-17.412, P<.05) 及T6 (β=-15.910, P<.05)，心臟功能分級在T1(β=-1.738, P<.05)、T2 (β=-2.100, P<.05)、T3 (β=-2.441 , P<.05)、T4 (β=-2.303 , P<.05)、T5 (β=-2.351 , P<.05)、T6 (β=-2.379 , P<.05)，心房利鈉因子在T2 (β=-1758.316, P<.05)、T3 (β=-2318.615, P<.05)、T4 (β=-1666.640, P<.05)、T5 (β=985.501, P<.05)、T6 (β=-2093.356, P<.05)，心室射出率在T5 (β=14.854, P<.05)、T6 (β=17.056, P<.05)，生活品質總分在重複測量時間後發現，T1(β=-13.858，P<.05)、T2 (β=-21.858，P<.05)、T3 (β=-28.335，P<.05)、T4(β=-32.732，P<.05)、T5 (β=-31.860，P<.05)、T6 (β=-33.548，P<.05)，死亡率預測在第12個月進行後測，實驗組平均數為15.19(±5.69)，對照組平均數為18.24(±8.09)，呈現兩組有其顯著差異(Z=-6.846，P<.05)。廣義估計方程式在T6 (β=-8.370， P<.05)，有其顯著差異(P<.05)。實驗組在營養狀況、生活品質、死亡率預測皆顯著優於對照組。
結論：本研究發現營養介入後有助於改善心衰竭病人的營養狀況、生活品質和降低死亡率，提供臨床護理人員在照顧此類個案時之生理數值及心理狀態，根據研究結果，期望提供醫療人員評估心衰竭病人時，即早發現個案營養問題及生活品質等困擾。未來可以延續此介入性研究來探討對於心臟復健之影響。

關鍵字

心衰竭 ； 營養 ； 生活品質 ； 死亡率

並列摘要

Background: Heart failure is a progressive syndrome. The heart cannot supply blood to various organs of the body, which increases the resistance of vasoconstriction and causes heart load, which accelerates its decompensation. The risk of malnutrition in acute heart failure is high, and undernutrition can also cause low cardiac output intermittently and affect the contractility of the heart, which will eventually lead to insufficient perfusion of multiple organs, which will affect the patient's nutritional status and quality of life in the long trun , and even increased mortality.
Objective: This study aims to understand the correlation between nutritional intervention on nutritional status, quality of life and mortality in patients with heart failure.
Methods: This study adopts a quasi-experimental design with two groups of pre-test and post-test, with longitudinal tracking and convenience sampling method, taking patients with acute heart failure in the cardiology ward of a teaching hospital in the south. A total of 73 people were the research subjects. The research design of nutritional intervention measures and random sampling was adopted, and the participants were divided into two groups. In addition to general disease health education, the experimental group was additionally given nutritional intervention health education (n = 40), and the control group The group received general disease education only (n = 33). Both groups used Nutritional Risk Screening. The experimental group was given nutritionally interventional formula milk drinks. They were followed up for 12 months after admission, one week after discharge, and 5 return visits. After health education was given, the nutritional risk index ( Geriatric nutritional risk index (GNRI), quality of life scale (Minnesota Living with Heart Failure Questionnaire) and mortality prediction table (Meta-Analysis Global Group in Chronic Heart Failure; MAGGIC Risk), patients were pre-tested at admission (T0) After being given nutritional intervention measures and health education during the hospitalization and filling out the questionnaire, they were discharged from the hospital for relevant consultation and health education guidance again, and returned to the clinic one week after discharge (T1), the first month (T2), and the third month (T3). ), the sixth month (T4), the ninth month (T5) and the twelfth month (T6) were all post-tested.
Results: After nutritional intervention in the experimental group, the generalized estimating equation was used to analyze the effectiveness of heart failure patients. The analysis results showed that albumin was at T6 (β=0.434, P<.05), and heartbeat was at T5 (β=-17.412, P<.05). .05) and T6 (β=-15.910, P<.05), cardiac function grades in T1 (β=-1.738, P<.05), T2 (β=-2.100, P<.05), T3 (β =-2.441 , P<.05), T4 (β=-2.303 , P<.05), T5 (β=-2.351 , P<.05), T6 (β=-2.379 , P<.05), atrial Natriuretic factor at T2 (β=-1758.316, P<.05), T3 (β=-2318.615, P<.05), T4 (β=-1666.640, P<.05), T5 (β=985.501, P <.05), T6 (β=-2093.356, P<.05), ventricular ejection rate at T5 (β=14.854, P<.05), T6 (β=17.056, P<.05), total score of quality of life After repeated measurement times, it was found that T1 (β=-13.858, P<.05), T2 (β=-21.858, P<.05), T3 (β=-28.335, P<.05), T4 (β= -32.732, P<.05), T5 (β=-31.860, P<.05), T6 (β=-33.548, P<.05), the mortality prediction was post-tested at the 12th month, and the average The number was 15.19 (±5.69), and the average number of the control group was 18.24 (±8.09), showing a significant difference between the two groups (Z=-6.846, P<.05). The generalized estimating equation had a significant difference (P<.05) at T6 (β=-8.370, P<.05). The nutritional status, quality of life, and mortality prediction of the experimental group were significantly better than those of the control group.
Conclusion: This study found that nutritional intervention can help improve the nutritional status, quality of life and reduce mortality of heart failure patients, and provide clinical nurses with physiological values and psychological states when caring for such cases. According to the results of the study, it is expected to provide medical personnel with evaluation For patients with heart failure, early detection of nutritional problems and quality of life problems. In the future, this interventional study can be continued to explore the impact on cardiac rehabilitation.

並列關鍵字

Heart failure ； Nutrition ； Life quality ； Mortality

參考文獻

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