血液透析中心患者之營養評估

Nutritional Assessment in Hemodialysis Center

董萃英(Tsuey-Ing Doong) ； 陳振文(Tzen-Wen Chen) ； 章樂綺(Leh-Chii Chwang) ； 吳義勇(Yee-Yung Ng)

《中華民國營養學會雜誌》 23卷2期 (1998/05) Pp. 123-131

https://doi.org/10.6691/JCNS.199805_23(2).0001

摘要

本研究以臺北榮總血液透析中心之66位患者進行營養評估，評估項目包括乾體重、上臂圍、三頭肌皮脂厚度、上臂肌圍、上臂肌肉面積、上臂脂肪面積、體脂肪等體位測量；血清白蛋白、淋巴球總數、膽固醇等生化檢驗；飲食蛋白質、熱量攝取量評估；並計算平均尿素濃度、蛋白質代謝率、Kt/V等。綜合受試者之三頭肌皮脂厚度、上臂圍、上臂肌圍測量，其中約42%患者低於25百分位，顯示患者有中度營養缺乏情形，長期蛋白質熱量攝取不足。與營養不良有關的生化檢驗值主要分布在輕度缺乏至正常參考值之範圍。平均尿素濃度為35.0±10.9mg/dl，而Kt/V為1.3±0.1，均在適當透析之範圍。由每日尿素產生率計算得之蛋白質代謝率為0.82±0.16g/kg/d，或由營養師計算之蛋白質攝取量為0.86±0.22g/kg/d，則均較建議量為低。年齡愈長之患者，其蛋白質熱量攝取愈低，亦是需積極營養支持的對象。藉由營養狀態評估，瞭解患者之營養狀態，並給予營養支持及營養教育，進而改善營養狀態，促進良好的透析。

關鍵字

營養評估 ； 體位測量 ； 蛋白質代謝率

並列摘要

Sixty-six uremic patients who received hemodialysis (HD) treatment in VGH-Taipei were studied for nutritional status and adequacy of dialysis. Nutritional assessment items included measurements of dry body weight, AMA, TSF, AMAC, AMFA, body fat analysis, and dietary intake of protein and calories. The biochemical examinations of albumin, TLC and cholesterol, time-averaged urea concentration, protein catabolic rate and Kt/V were checked. Fouty-two percent of the subjects had anthropometric measurements below 25 percentile, indicating that some subjects had moderate nutritional depletion and chronic protein-calorie malnutrition (PCM). PCM-related biochemical parameters were within the normal to mild deficit range. Subjects with an acceptable value for TAC urea (35.0±10.9mg/dl) and Kt/V (1.3±0.1) indicated adequate dialysis. The PCRn, calculated from the urea generation rate was 0.82±0.16g/kg/d, and the average protein intake (PIn) was 0.86±0.22g/kg/d. Both PCRn and PIn were lower than the recommended protein intake values. Elderly subjects who had less protein and calories intake need aggressive nutrition support. Adequate food intake and good nutritional status are pivotal for successful dialysis. Nutritional assessment was done to determine the patients' nutritional status and to uncover cases who are at risk of malnutrition, so that nutritional support and nutritional education can be provided by dietitians to achieve adequate dialysis.

並列關鍵字

nutritional assessment ； anthropometric measurements ； protein catabolic rate