| 摘要: | 心血管疾病（cardiovascular disease, CVD）為血液透析（hemodialysis patients, HD）患者主要的死亡原因，其風險因子可藉由飲食來達到預防及改善的效果。血液透析患者健康飲食指數（Healthy Eating Index in HemoDialysis patients, HEI-HD）為一種適合評估HD患者之飲食評量指數，與CVD風險和死亡相關。目前尚未有研究指出針對HD患者之最佳教育模式，故本研究目的為探討營養師（對於患者或護理師）提供以HEI-HD為基礎發展相關的營養教育教案與教材，對HD患者CVD風險因子之影響。本研究為準實驗設計（quasi-experimental design），依教育模式分為4組，包括（1）完全對照組（無提供課程，僅提供手冊）（no courses for patients and nurses, Non-C）、（2）僅給予護理師課程介入組（course for nurses, CN）、（3）僅給予患者課程介入組（course for patients, CP）以及（4）給予患者及護理師課程介入組（course for patients and nurses, CPN）。於實驗起始期、介入期及追蹤期對患者進行評估。收集患者人口統計學、血液生化數值、飲食紀錄及飲食知識問卷。共分析120名HD患者的資料（年齡為57.9 ± 10.0歲）。結果顯示，與Non-C組相比，CPN組血清總膽固醇、鈣、同半胱胺酸及白蛋白在介入期及追蹤期均改善。CPN組於介入期之血清總膽固醇的改善顯著優於其他3組之教育模式。綜上所述，以HEI-HD為基礎之營養教育能夠改善HD患者的CVD風險因子，透過營養師給予護理師正確的飲食觀念，共同照護HD患者的教育模式對於改善CVD風險因子為最佳組合。
Cardiovascular disease (CVD) is the leading cause of death in hemodialysis (HD) patients, and its risk factors can be prevented and improved through diet. The Healthy Eating Index in Hemodialysis patients (HEI-HD) is a scale for assessing the diet quality, closely associate with the CVD risks, and death. So far, no study was conducted to find the best education approach for HD patients. Therefore, this study was to investigate the effect of newly developed nutritional education teaching plans and material based on HEI-HD which delivered by dietitians (to patients, or to nurses) on CVD risk factors in HD patients. A quasi-experimental design was conducted on 4 groups accordingly 4 approaches, including (1) control group (or no course, only booklet) (Non-C), (2) given courses to nurses only (CN), (3) given courses to patients only (CP), and (4) given courses to both patients and nurses (CPN). Patients were assessed at the baseline, right after intervention and at 4th months of follow-up. Data were collected including sociodemographic, biochemical parameters, diet records, and diet knowledge questionnaire. A sample of 120 HD patients (aged 57.9 ± 10.0 years) were analyzed. Results showed that, compared with Non-C group, CPN group illustrated the improvement of serum total cholesterol (TC), calcium, homocysteine and albumin at the intervention and the follow-up period. The improvement of serum TC in the CPN group during the intervention was significantly better than other 3 groups. To conclude, the nutritional education based on HEI-HD can improve the CVD risk factors of HD patients. Dietitians are encouraged to share with nurses about the nutrition care and educate HD patients which could maximize the effect and improve the CVD risk factors. |
