| 摘要: | 心血管疾病（Cardiovascular disease, CVD）為血液透析（Hemodialysis, HD）患者最常見之併發症，可透過營養師提供之營養教育改善其整體飲食及飲食脂肪攝取型態，降低罹患CVD之風險。建議由血液透析患者健康飲食品質指標（Healthy Eating Index for HemoDialysis patients, HEI-HD）及降血膽固醇/促血膽固醇比（Hypocholesterolaemic/hypercholesterolaemic ratio, h/H）評估整體飲食及飲食脂肪品質，準確評估HD患者飲食及提供適切營養教育對透析預後實為重要。迄今尚未有研究探討HD患者飲食脂肪品質與CVD風險因子之關係，故本研究欲觀察HD患者h/H與CVD風險因子之關係，再進一步探討何種營養教育介入模式可改善HD患者飲食脂肪品質及其CVD風險因子，並找出最適合HD患者之營養教育模式。此為準實驗設計，於2019年5月至2021年4月於北部四家醫院進行收案，並分成起始期、介入期與追蹤期，每組皆提供患者與護理師營養教育手冊，未提供營養教育課程組（No course for patients and nurses, Non-C）未提供患者與護理師營養教育、護理師營養教育課程組（Course for nurses, CN）僅提供護理師營養教育、患者營養教育課程組（Course for patients, CP）僅提供患者營養教育、護理師與患者營養教育課程組（Course for patients and nurses, CPN）提供患者與護理師營養教育。紀錄患者基本資料、血液生化數值、飲食內容並計算HEI-HD分數與h/H。共119位HD患者納入分析，得h/H與身體質量指數（Body mass index, BMI）呈負相關，與高密度脂蛋白膽固醇（High density lipoprotein cholesterol, HDL-C）呈正相關。與Non-C組相比，CPN組之HEI-HD分數、h/H、及HDL-C顯著增加，血清總膽固醇顯著下降。以上結果表示h/H可預測HD患者CVD風險因子，h/H增加進而改善HD患者血脂異常，證實同時提供患者與護理師營養教育的模式為最適合HD患者之營養教育模式。
Cardiovascular disease (CVD) is the most common complication of hemodialysis (HD) patients. Nutritional education provided by dietitians could improve the overall diet and dietary fat intake patterns, and reduce the risk of CVD. Healthy Eating Index for HemoDialysis patients (HEI-HD) and hypocholesterolemic/hypercholesterolemic ratio (h/H) were suggested to measure overall diet quality and the dietary fat quality, respectively. The accurate assessment of the diet in HD patients and provision of appropriate nutrition education are important to improve the dialysis outcomes. However, no studies have investigated the relationship between dietary fat quality (using h/H) and CVD risk factors in HD patients. Therefore, the aim of this study was to examine the association between h/H and CVD risk factors, and further explore which nutritional education intervention model could improve dietary fat quality and CVD risk factors in HD patients. A quasi-experimental design was conducted on four groups (No course for patients and nurses in Non-C group, course for nurses in CN group, course for patients in CP group, and course for patients and nurses in CPN group), from May 2019 to April 2021. Nutrition education booklets were provided to patients and nurses. Data were collected at baseline, intervention and follow-up period, including patient's basic information, blood biochemical data, diet content and calculated HEI-HD and h/H. Total of 119 HD patients were included in the analysis. The results showed that h/H was negatively correlated with body mass index (BMI) and positively correlated with high density lipoprotein cholesterol (HDL-C). Compared with the Non-C group, CPN group was significantly higher in HEI-HD, h/H, HDL-C and significantly lower in serum total cholesterol. In conclusion, it indicates that h/H could predict CVD risk factors in HD patients, and the higher of h/H is helpful for improving dyslipidemia in HD patients. |
