重症急性腎損傷病人之營養評估與介入

Nutritional Assessment and Intervention in Critically Ill Patients With Acute Kidney Injury

洪凱殷(Kai-Yin Hung) ； 邱鼎育(Terry Ting-Yu Chiou)

《腎臟與透析》 32卷4期 (2020/12) Pp. 188-196

https://doi.org/10.6340/KD.202012_32(4).0005

摘要

由於加護病房（intensive care unit, ICU）中的急性腎損傷（acute kidney injury, AKI）患者經常出現其他器官功能衰竭，因此營養師必須考慮各個疾病的治療準則，並與醫療團隊討論製定最適合病人的營養計畫。而且，這個計劃必須隨時依著病人的病情做適當的修正。在高雄長庚ICU中，AKI病人照會營養師的原因分析：內科ICU的照會多為腹瀉、低白蛋白血症、胃殘留量過多導致灌食未達理想劑量；外科ICU則以病人需全靜脈營養，術後開始腸道餵食及低白蛋白血症居多。本文也透過兩個臨床個案分析，期能讓讀者更明白營養評估及介入過程之諸多思維及考量。

關鍵字

急性腎損傷 ； 營養 ； 加護病房 ； 低白蛋白血症

並列摘要

Critically ill patients with acute kidney injury (AKI) often have multi-organ failure, dietitians must discuss with the medical teams to make appropriate nutritional interventions based on the guidelines for their underlying diseases. Furthermore, every nutritional plan should be monitored and revised continuously in order to meet patients' medical situation. In Kaohsiung Chang Gung Memorial Hospital, patients with AKI in medical intensive care units (ICU) often consult dietitians for diarrhea, hypoalbuminemia, and high gastric residue after feeding which affect energy intake. In the surgical ICU, however, the top three reasons for consulting dietitians are total parenteral nutrition needed, starting enteral feeding after surgery and hypoalbuminemia. Through the analysis of two clinical cases, we hope to illustrate the important elements underlying the nutritional assessment and intervention.

並列關鍵字

acute kidney injury ； nutrition ； ICU ； hypoalbuminemia