有鑑於台灣長期使用呼吸器病患人數之逐年增加,為了提升醫療品質,降低健保支出,故針對此類病患利用臨床常見之營養評估工具迷你營養評估量表 (Mini nutritional assessment, MNA)、主觀性營養評估量表 (Subjective goal assessment, SGA) 及老人營養風險指標 (Geriatric nutritional risk index, GNRI),來探討何者可用來評估此類病患之營養狀況,以利營養師臨床之應用。收集68位來自兩所不同醫院層級呼吸治療病房 (respiratory care ward, RCW) 長期使用呼吸器病患,發現GNRI相較於MNA 及SGA在「正常組」及「營養不良危險組」中與白蛋白、身體質量指數、最大吸氣壓力具有顯著組間差異性並呈現正相關。以ROC curve分析,GNRI相較於MNA及SGA具有較高之效度。更進一步以GNRI之四個層級進行比較,結果顯示GNRI之層級差異與病患之體重、身體質量指數、白蛋白具有顯著差異,表示隨著GNRI分數之上升,病患有較佳之營養狀況,且最大吸氣壓力亦有此趨勢。故認為針對RCW長期使用呼吸器病患,GNRI較能作為此類病患之臨床營養評估工具,以輔助營養師臨床之應用。
Long term mechanically ventilated (LTMV) patients were increased in Taiwan. To increase the quality of medical and decrease the spend of health insurance, we used Subjective Global Assessment (SGA), Mini Nutritional Assessment (MNA) and Geriatric Nutritional Risk Index (GNRI) to set up an early assessment tool of nutrition status may help in monitoring patients in time. 68 patients completed this study who were from respiratory center ward (RCW) of Keelung Hospital, Department of Health Executive Yuan, R.O.C. and Jen-Kang Hospital in 2006. GNRI has significant difference between “normal” and “at risk” and positive correlation with albumin, body mass index (BMI) and maximal inspiratory pressure (Pimax) than in MNA and SGA. In validity, GNRI better than MNA and SGA can avoid to loss patients who were at risk. To identified the GNRI deeply, there are significant difference with albumin, BMI, Pimax in four levels. It confirmed as GNRI levels increased, indeed can respond to nutrition status. In conclusion, Geriatric nutritional risk index (GNRI) can be an assessment tool to response the nutrition status of LTMV patients in RCW.