管灌飲食對護理之家住民營養狀態影響之回溯性分析

Nutritional Status of Tube-feeding Institutionalized Residents – A Retrospective Study

目的：探討護理之家住民長期使用管灌飲食與一般經口進食者間，其營養狀態是否差異及其相關影響因子。方法：本研究為病歷回溯性資料分析，由西元2009年1月1日到2009年12月31日間，以居住北部某護理之家住民中，曾接受當年度健康檢查住民之所有病歷資料納入分析。除了收集健康檢查資料中各項生理及生化數據外，還包括住民基本資料、過去慢性疾病史（如：糖尿病、高血壓、高血脂、失智及腦血管疾病等常見慢性疾病）、定期迷你營養評估篩檢量表、以及於體檢後三個月內急診及住院次數；統計方法包括描述性分析、魏可遜二樣本檢定、卡方同質性檢定及邏輯斯迴歸分析。結果：總共收集到78筆住民資料，其中男性佔40位（51.3%），使用管灌飲食者55位（70.5%），經迷你營養評估篩檢量表評估，營養狀況不佳者共有47位（60.3%）。比較管灌組與經口組住民二者，在各項營養指標及三個月內急診及住院次數等記錄上，發現管灌組整體營養表現較差，如：定期迷你營養評估篩檢量表經口組與管灌組，分數分別為11.5±1.4及10.7±1.2 （p=0.012）；小腿圍分別為30.0±4.9 cm，27.7±3.1 cm（p=0.048）；總膽固醇濃度分別為183.5±31.0 mg/dL與161.2±31.2 mg/Dl（p=0.003）；C-反應蛋白濃度分別為0.29±0.27 mg/dL，0.50±0.39 mg/dL (p=0.008)，以及白血球數目分別為6.17±1.34×103/μL，7.50±1.85×103/μL （p=0.001）。且管灌組在體檢後三個月急診就醫次數顯著高於經口組（0.6±0.9，0.2±0.7，p=0.039）。於卡方同質性檢定中，發現不同進食方式，與性別及過往慢性疾病史間無顯著差異。另外在以迷你營養評估篩檢量表結果為依變項，進行邏輯斯複迴歸分析中，發現營養不良篩檢結果會與小腿圍（OR: 9.473，p=0.001）及低總膽固醇（OR: 4.725，p=0.002）有統計上之顯著關聯性。結論：本研究之結果發現，長期使用管灌飲食之住民相較經口進食者，營養狀態較差，急診就醫次數增加，其原因可能與慢性發炎狀態相關。而早期可評估評估住民營養方法，除選擇迷你營養評估篩檢量表外，藉由簡易量測小腿圍及血中總膽固醇濃度，都將有助於瞭解住民之營養情形。

Background: Overseas medical support is an emerging issue in international health care and a part of our community experience in Family Medicine. This study investigated physician diagnoses found during our experience with overseas short-term medical support. Methods: After an evaluation of local needs, general practitioners and ophthalmologists were invited to join the team. We collected medical records during overseas medical support in a South Pacific country for two years. Data included basic information about cases, medical complaints, physicians' diagnoses and recommendations, measurements of blood pressure and blood sugar, prescriptions and referral records. We classified patients into two groups, one for the departments of family medicine, internal medicine, and pediatrics, and the other for the department of ophthalmology. Results: After patients with incomplete information about about gender and age were excluded, a total of 2572 individuals were seen over the 2-year period, 1283 in 2010 and 1289 in 2011. The results showed that more women than men sought medical treatment. Age ranged from 2 weeks to 91 years. The mean age was 37.4 in the general section, and 51.2 in ophthalmology. Most patients were aged 40-65. Most general medical patients complained of body aches, as musculoskeletal diagnoses accounted for nearly 40%. These were followed by skin diseases, respiratory diseases, hypertension, and cardiovascular diseases. Of the vision problems seen by ophthalmologists, 64.3% were presbyopia, 17.3% were cataracts, and 13.7% were chronic conjunctivitis. The referral rate was 3%. Conclusions: Although the overseas medical support team performs only short-term medical services, they are welcomed because of a lack of medical support in the local region. The chief complaints and types of diseases are mostly within the scope of family medicine. Medical supplies and medications should therefore be prepared in accordance with common medical needs.