行經冠狀動脈繞道手術術後一星期的營養探討

The One Week Nutrition Survey of Patients undergoing Coronary Artery Bypass Graft Surgery

謝素琴(Shu-Chin Hsieh)

指導教授 ： 陳佳慧

國立臺灣大學/醫學院/護理學研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.02178

摘要

冠狀動脈硬化屬文明疾病，每年因此而開冠狀動脈繞道手術的病人甚多，然術後進食營養狀況鮮少列為追蹤項目。臨床上熱量估算有各種方式，文獻上公認用間接熱量測量法(IC)所測出的熱量是最為精確的計算方法。
是以本研究目的在於探討經冠狀動脈繞道手術術後一星期的營養給予狀況，與IC的差距，謂之熱量差距；同時探討入院、出院前及出院後2~4週等3個時段營養狀態的改變。研究設計採立意取樣，於北部某一佔床2200床的醫學中心，選取罹患冠心病經醫師診斷須接受冠狀動脈繞道常規手術，預估住院天數大於七天的病人作研究；收案時間自99年4月至99年 9月止，總計收案人數43名，採3階段收案，入院時收集人口學特性、疾病特性及營養狀態評估資料:如迷你營養評估量表(MNA)、身體質量指數(BMI)、體位測量(CC、MAC)；術後收集IC與連續七天飲食記錄；出院前與出院後2~4周，收集MNA、BMI、CC、MAC等資料。資料分析採用SPSS16.0版軟體，作描述性統計。
結果顯示: (一)以IC*1.2估算個案熱量所需減去個案實際攝取熱量所得到的熱量差距:手術當日差距-1847.3 ± 465.5卡，手術後第六天差距-712.3 ± 530.4卡，連續七天累進差距達7713.6 ± 3100.5卡。出院前97%的住院病患體重減少，平均減少2.73 ± 2.30公斤。連續7天有53%(N=23)的收案病患每日熱量攝取均少於75%，連續7天有21%(N=9)的收案病患每日熱量攝取均少於50% (二)營養狀態的改變: 大部分的營養狀態參數在3個測量時間點均是減少的趨勢，僅MNA、CC出院後2~4周有回升現象。
整體而言，研究結果顯示:43位經冠狀動脈繞道手術的收案個案，術後的熱量差距和體重減少是普遍存在現況。

關鍵字

冠狀動脈手術 ； 營養差距 ； 營養評估 ； 體重改變

並列摘要

Energy deficit, defined by the discrepancies between recommended and actual oral caloric intake was a common problem in acute and critical care settings. The aim of this study was to evaluate the energy deficit one week after patients undergoing coronary artery bypass graft surgery. The nutritional status of these patients was also evaluated following the hospitalization at three time points: admission, before discharge, and 2-4 weeks after hospital discharge. The sample consists of 43 participants who were scheduled for an elective coronary artery bypass graft surgery from April to September 2010 at a 2200-bed unban medical center. All participants’ resting energy expenditures were measured once by Indirect Calorimetry within 24 hours after surgery. The obtained resting energy expenditure times 1.2 was then defined as recommended energy requirement. Participants were closely monitored on their actual calorie intake through 7-day daily intake food record to calculate the energy deficit. A structured nutrition assessment including anthropometrics and a Mini-Nutritional Assessment Questionnaire was conducted three times following hospitalization.
Data revealed that energy deficit between recommended and actual intake were -1847.3±465.5 kcal on surgical day. On day 7, this deficit was -712.3±530.4 kcal. The accumulated mean deficit within 7 days was 7713.6±3100.5 kcal. The energy intake failed to exceed 75% of daily requirement on all 7 days for 53.3% of the sample. The average daily energy intake failed to 50% of daily requirement on all 7 days for 21% of the sample. Weight change was significant with 97% participants experienced weight loss and lost on average of 2.73±2.30 Kg by discharge. Most nutrition parameters declined 2-4 weeks following hospitalization.
The result suggests that energy deficit and weight loss was common among patients undergoing coronary artery bypass graft surgery.

並列關鍵字

Coronary Artery Bypass Graft Surgery ； Energy Deficit ； Nutrition Survey ； Weight Loss

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