建立團隊照護模式並以CONUT介入呼吸照護病人後之營養改善成效

Using CONUT Score and a Care Team Model to Improve the Nutritional Status of Patients with Prolonged Mechanical Ventilation

許多研究指出，早期且適當的營養支持對於仰賴人工呼吸器的病人是必要的，因此本文目的旨在於探討醫院成立呼吸照護中心病人營養改善專案之成效。本專案乃於100年3月1日至100年12月31日以桃園某區域教學醫院的呼吸照護中心病人為改善對象，建立醫師、營養師與呼吸治療師共同照護模式，並以CONUT評估呼吸照護中心病人營養狀態。專案改善期間共完成56位呼吸照護中心病人之收案，每人至少有3次白蛋白、總膽固醇及淋巴球總數的抽血檢驗值，平均年齡為74.55±13.12歲（範圍49-97歲）。改善前，呼吸照護中心病人營養不良率（重度、中度、輕度營養不良）高達100%，經過建立團隊共同照護模式並積極介入營養改善後，病人轉出時的營養不良率降為83.9%，而且中重度營養不良率由改善前的67.9%降為48.2%，本專案對於呼吸照護中心病人的營養狀態具統計上顯著改善效果，而且成功呼吸器脫離率也有提升趨勢，因此建議，對於呼吸器依賴病人之營養照護，應建立團隊共同照護模式，並以容易獲得且具代表性的營養篩選工具評估營養狀態，以及早介入改善措施，才能不斷提升病人的醫療照護品質。

Early and appropriate nutritional support has been proven to be important for patients requiring mechanical ventilation in many studies. This paper aimed at evaluating the efficacy of a project, which is designed to improve the nutritional status among patients with prolonged mechanical ventilation. This project involves establishing a new care team model-composed of primary care physicians, dietitians, and respiratory therapists, in addition, it uses Controlling Nutritional Status (CONUT) nutritional score as objective measurement. From March 1 to Dec 31, 2011, fifty-six patients admitted to respiratory care center (RCC) were enrolled. Each patient had been evaluated for serum albumin, total cholesterol and total blood lymphocyte counts for more than three times during the evaluation. The average age was 74.55 ±13.12 years old (ranging from 49 to 97). Before implementing the project, 100% of the RCC patients suffered from malnutrition in varying degrees (severe, moderate and mild). After receiving the team care and aggressive nutritional intervention guided by CONUT score, the malnutrition rate decreased to 83.9% when the patients were transferred out. Among them, severe and moderate malnutrition rates were reduced substantially from 67.9% to 48.2%. In conclusion, this project improved RCC patients’ nutritional status with statistic significance and increased successful weaning rate from ventilator as well. To improve the quality of care among patients receiving prolonged mechanical ventilation, we recommend early intervention, care team model and a nutritional scoring system that is easy to access and with good representation.