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    题名: 慢性腎臟病之臨床營養支援系統開發與研究
    作者: 陳立甫
    贡献者: 醫學資訊研究所
    日期: 2010
    上传时间: 2010-09-09 11:47:31 (UTC+8)
    摘要: 根據衛生署的統計資料，自2002年至2008年止，腎炎、腎徵候群及腎變性病一直高居國人十大死亡原因的第8位、第10位。另一方面，依據2007年美國腎臟病資料登錄系統(United States Renal Data System, USRDS)統計，台灣末期腎病(end stage renal disease, ESRD)的發生率和盛行率，均為世界第一。而目前國內洗腎病患更是年年增加，造成健保龐大支出，已成為健保支出的首位。

    因此慢性腎臟病早期階段的防治工作更為重要，目前國內已有全國性的慢性腎臟病共同照護網，藉由多專業的照護，慢性腎臟病患者可藉由衛教師和營養師得到更多疾病照護知識和飲食方法，期望可延緩慢性腎臟病進程，更進一步延長國人的壽命和提升生活品質。

    本研究以營養的觀點，開發一輔助臨床營養師之資訊系統，藉由整合檢驗數據和病患基本資料，更有效的做臨床營養評估和治療。藉由電腦系統可更快速且精確的計算腎絲球過濾率(glomerular filtration rate, GFR)等相關腎臟功能指標，以及蛋白質和熱量等相關需要特別控制的營養成分，並提供相關參考指引做提示。期望藉由營養資訊系統的發展更有效的改善慢性腎臟病患的飲食狀況，並有助於了解長期照護的病患其病程發展和營養改善狀況，進一步改善或延緩病情發展。


    According to the statistics from Department of Health, disease diagnosis nephritis, nephrotic syndrome and nephrosis has been ranked in the 8th or 10th among the top 10 causes of death from 2002 to 2008. On the other hand, according to the 2007 statistics of United States Renal Data System (USRDS), end stage renal disease (ESRD) incidence and prevalence in Taiwan are both 1st in the world. The number of dialysis patients is increasing every year in Taiwan. This issue causes enormous health care spending and has become the top expenditures in the record of National Health Insurance.

    Therefore, the prevention and control of early stage of chronic kidney disease (CKD) is increasing more important. Now we have a common care network for CKD patient, through much professional care, CKD patients can get more knowledge of diseases care and diet methods by consultations through the health care providers and dietitians. This process is expected to prolong the CKD patients’ lives and improve their quality of life.

    In this study, an information system that was developed to assists in clinical dietitians. This system integrates the laboratory data and patient’s basic information, and more effectively to do the clinical nutritional assessment and treatment. By the computer system, the glomerular filtration rate (GFR) and other related indicators of kidney function can be calculated more quickly and accurately, as well as protein and calorie control and other related nutrients, and provide relevant information and tips. Clinical Nutrition Support System designed by us is expected to effectively improve the CKD patients’ diet, and help researchers to understand the long-term care of patients whose course development and nutrition, in order to halt the progression of CKD.
    描述: 審定書 ii
    博碩士論文電子檔案上網授權書 iii
    誌謝 iv
    目錄 v
    表目錄 viii
    圖目錄 ix
    中文摘要 xi
    Abstract xiii
    第一章 緒論 1
    1.1 前言 1
    1.2　研究動機 2
    1.3　研究目的 2
    第二章 文獻探討 4
    2.1 腎臟的構造 4
    2.2 腎臟生理功能 5
    2.3 慢性腎臟病 5
    2.4慢性腎臟病之死亡率與醫療費用 7
    2.5 尿毒症 8
    2.6 透析治療(dialysis) 9
    2.7 Kidney Disease Outcomes Quality Initiative (K/DOQI) 10
    2.8 主觀性整體營養評估(subjective global assessment, SGA) 11
    2.9 替代健康飲食指標（alternate healthy eating index, AHEI） 11
    2.10 常見的營養不良 13
    2.11 評估腎功能的方法 15
    2.12 慢性腎臟病與營養治療 18
    2.13 相關營養系統概況 20
    第三章 研究方法 21
    3.1 研究架構 21
    3.2 檢驗數據之參考值建立 22
    3.3 熱量及營養素攝取建議量建置 23
    3.4 腎絲球過濾率(Glomerular filtration rate, GFR)計算公式 24
    3.5 料理資料庫與食品營養成分資料庫建置 25
    3.6 系統架構與建置工具 27
    3.7 系統功能設計 28
    3.8 系統評估 31
    第四章 研究結果 33
    4.1 系統開發工具 33
    4.2 系統資料庫設計 33
    4.3系統功能規劃 34
    4.4 系統前台功能 36
    4.5系統後台功能 45
    4.6問卷調查結果 50
    第五章 討論 54
    5.1 營養支援系統的臨床應用 54
    5.2 料理資料庫 55
    第六章 結論與未來研究方向 56
    6.1結論 56
    6.2未來研究方向 56
    參考文獻 58
    附錄一 慢性腎臟病之臨床營養支援系統滿意度調查問卷 62


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