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| 題名: | 營養衛教介入對血液透析病患蛋白質及熱量營養狀況的影響
Effects of nutritional education on protein and energy wasting in hemodialysis patients |
| 作者: | 康甄真
Kang Chen-Chen |
| 貢獻者: | 保健營養學研究所
趙振瑞n |
| 關鍵詞: | 碩士
指導教授-趙振瑞
委員-盧國城
委員-陳淑子
血液透析;營養不良發炎分數
hemodialysis;malnutrition inflammation score |
| 日期: | 2010 |
| 上傳時間: | 2010-10-20 12:39:23 (UTC+8) |
| 摘要: | 長期血液透析患者常發生蛋白質熱量耗損(protein-energy wasting, PEW)，因此定期評估和監測蛋白質熱量營養狀態，並給予適當之治療是非常重要，且其與長期血液透析患者發病及死亡率之增加具有強烈的相關性。本研究擬探討給予營養不良的血液透析患者3次營養衛教課程，是否能改善熱量與蛋白質營養不良。以北部某教學醫院長期血液透析患者50人進行試驗。在全程的營養衛教過程是採用一對ㄧ的訪談方式，每次衛教時間約20-30分鐘，然後分別接受三階段的營養衛教課程，包括第一階段為熱量及蛋白質足夠的攝取；第二階段為飲食中食物攝取的限制及控制；第三階段為外食及節慶飲食的認識。另外收集紀錄身體質量指數(body mass index, BMI)、生化檢驗值，如：白蛋白、肌酸酐、總膽固醇，以及營養不良發炎分數(malnutrition inflammation score, MIS)等資料分析，結果顯示：在營養衛教介入後，介入組的認知及態度平均分數顯著增加31 (P＜0.01)及3 (P＜0.01)分；在BMI部份，介入組由23.1 ± 4.2 kg/m2顯著上升至23.4 ± 4.2 kg/m2；在生化檢驗值部份，介入組之白蛋白由3.8 ± 0.2 g/dL顯著上升至4.0 ± 0.3 g/dL，以及MIS營養評估分數，介入組由4.8 ± 2.4顯著下降至3.8 ± 2.3。結論：營養衛教的介入對於長期血液透析患者，無論在認知與態度上有顯著的進步之外，BMI及白蛋白也有顯著的改善，而對於整體的營養不良發炎分數也有顯著下降，顯示營養衛教能改善血液透析患者的營養狀況，故應有持續的營養衛教介入，來達到修正及改善整體血液透析的飲食生活習慣，進而改善血液透析患者營養不良的危險性，同時降低因營養不良所引起的併發症及死亡率。
Protein-energy wasting (PEM) is very common in patients with chronic hemodialysis (CHD). Routine assessment and monitor in the nutritional status of protein and energy are crucial to prevent, diagnose and treat PEW, for the reason that PEW is strongly correlated with the increasing morbidity and mortality in CHD patients. This study was to investigate whether protein-energy malnutrition in the CHD patients can be improved after the intervention of three-session nutritional education. The patients were recruited from the teaching hospital in northern Taiwan. The screened subjects participated volunteerly after completing the consent form. The selected patients were divided by purposive sampling into two groups with 25 subjects in each: the control and intervention groups. This three-session nutritional education is given by one-to-one for 20~30 minutes in each session, and the topics for nutritional education in order included proper intake of protein and energy, the limitation and control of the diet, and eat-out and diet on holidays. After the analysis of body mass index (BMI), biochemical assessment, such as albumin, creatinine and total cholesterol, and malnutrition information score (MIS), the results revealed that after the intervention of the nutritional education, the cognition and attitude scores were significantly increased by 31 (P＜0.01) (out of full score 100) and 3 (P＜0.01) (out of full score 50), respectively. The intervention group also had a significant increase in BMI from 23.1 ± 4.2 to 23.4 ± 4.2 kg/m2. The biochemical assessment showed that serum albumin concentration in the intervention group increased significantly from 3.8 ± 0.2 to 4.0 ± 0.3 g/dL. However, the nutritional score of MIS in the invention group decrease significantly from 4.8 ± 2.4 to 3.8 ± 2.3.
In conclusion, in addition to the significant improvement in cognition and attitude of CHD patients after the intervention of nutritional education, there is also obvious improvement observed in their BMI and albumin values. A dramatic decline in MIS is observed at the end of the study. All these results indicate nutritional education to CHD patients is crucial for their nutritional status. As the result, the continuous intervention of nutritional education is necessary to improve dietary habits of CHD patients, and furthermore, to decrease the risk of morbidity and mortality along with malnutrition in CHD patients. |
| 關聯: | 97頁 |
| 描述: | 目 錄
中文摘要…………………………………………………………………...…Ι
英文摘要…………………………………………………………………... .ΙΙI
致謝…………………………………………………………………............. V
目錄………………………………………………………………….….….VII圖目次……………………………………………………………...………XII表目次……………………………………………………………………..XIII
第一章 研究動機與目的…………………………………..…………..….1
第二章 文獻回顧………………………………………………….….……3
第一節 血液透析患者之流行病學調查資料……………………..……3
第二節 血液透析患者常見的併發症…………………………………...5
第三節 血液透析患者之營養狀況……………………………………...6
第四節 血液透析患者營養評估之方法……………………………….12
第五節 血液透析患者的營養衛教介入……………………………….18
第六節 血液透析患者飲食衛教知識與疾病之相關性……………….21
第七節 血液透析患者的營養及飲食建議…………………………….25
第三章 實驗設計與方法…………………………...…………………….29
第一節 受試者標準與數目……………………………………………29
第二節 實驗設計與飲食衛教介入……………………………………30
第三節 分析方法及項目………………………………………………35
第四節 營養評估方式…………………………………………………37
第五節 統計方法………………………………………………………38
第四章 結果……………………………..……………………………….39
第一節 血液透析受試者基本資料……………………………………39
一、 受試者之基本資料…………………………………………..39
二、 受試者之飲食習慣…………………………………………..42
第二節 血液透析受試者認知及態度測驗之分數……………………44
一、 認知測驗……………………………………………………..44
二、 認知測驗題目之分類………………………………………..45
三、 態度測驗……………………………………………………..47
四、 態度測驗題目之分類………………………………………..48
第三節 血液透析受試者之年齡、教育程度、經濟狀況對認知及態度前後測分數與血液生化檢驗值、身體質量指數及營養不良分數之影響……………………………………………………………..50
一、 年齡與血液生化檢驗值、身體質量指數及營養不良分數之相關性…………………………………………………….…….50
二、 不同年齡對認知及態度前後測分數之影響………………..52
三、 不同教育程度與血液生化檢驗值、身體質量指數及營養不良分數之相關性………………..………………………………54
四、 教育程度高低與血液生化檢驗值、身體質量指數及營養不良分數之比較…………………………………………………..56
五、 不同教育程度對認知及態度前後測分數之影響…………..58
六、 經濟狀況與血液生化檢驗值、身體質量指數及營養不良分數之相關性…………………………… ……………………….60
七、 經濟狀況高低與血液生化檢驗值、身體質量指數及營養不良分數之比較…………………………………………………..62
八、 不同經濟狀況對認知及態度前後測分數之影響…………..64
第四節 營養衛教介入前後之臨床血液生化檢驗值、身體質量指數及營養不良分數的變化…………………...………………………...66
第五節 營養衛教介入後認知及態度測驗分數與血液生化檢驗值與其他指數之相關性………………………………………………..68
一、 認知及態度分數與血液生化檢驗值、身體質量指數、營養不良發炎分數之相關性………………………………………..68
二、 認知的高低分數與血液生化檢驗值、身體質量指數、營養不良發炎分數之比較…………………………………………..70
三、 態度的高低分數與血液生化檢驗值、身體質量指數、營養不良發炎分數之比較…………………………………………..72
第六節 血液透析受試者之介入組在血清白蛋白與認知及態度後測分數之結果………………………………………………………74
一、 介入組之血清白蛋白高低值與認知與態度前後測分數的關係………….…………………………………………………74
二、 介入組在血清白蛋白高低值分組對認知之蛋白質相關題目答對人數之比較…………….................................................76
第五章 討論…………………………………………………..………….78
第一節 營養衛教對於血液透析受試者之認知與態度之分析……….78
第二節 血液透析受試者之年齡、教育程度、經濟狀況對認知及態度前後測分數與血液生化檢驗值、身體質量指數及營養不良分數之影響………………………... …………………………………..80
第三節 營養衛教介入前後之臨床血液生化檢驗值的變化….. ……...83
第四節 營養衛教介入後認知及態度分數與臨床血液生化檢驗值及其他指數之分析………………………... ………………………85
第五節 血液透析受試者之介入組在血清白蛋白與認知及態度後測分數之分析………………………………………………………86
第六章 結論…………………………………………………..…….……87
參考文獻…………………………………………………………………….88
【附錄一 血液透析(洗腎)飲食考題效度專家審核名單】……………….94
【附錄二 營養衛教介入對血液透析的營養改善之基本問卷】…………95
【附錄三 血液透析(洗腎)飲食考題】……………………………………96
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