血液透析病患之營養狀況及其相關因素之探討

Association Factors of Nutrition Among Hemodialysis Patients

背景：營養不良是血液透析病患死亡的重要預測因素。
目的：了解血液透析病患營養狀況並分析其重要預測因素。
方法：本研究針對中部某區域教學醫院每周需進行3次血液透析之病患為對象，進行基本人口學資料、透析情形之病歷查閱，共收得有效樣本155位，進行描述性、相關與階層迴歸分析。
結果：血液透析病患女性占51.6％，平均年齡64.10±13.28歲，透析年資6.00±4.86年，營養狀況：血清白蛋白平均為3.81±0.36，血清白蛋白＜3.5佔14.8％；以階層迴歸分析血清白蛋白之重要影響因素，結果發現工作狀況為顯著預測變項，可解釋變異量為8.3％。
結論與應用：血液透析病患營養控制不良比率佔14.8％，無工作者其血清白蛋白顯著較低，又無工作者在年紀上明顯較高，因此建議未來可針對年齡較高者，可加強營養教育提升血清白蛋白，甚至健保若能提供類似糖尿病論質計價方式給付則有助於病人營養之控制。

Background: Malnutrition is an important predictor of mortality in hemodialysis patients.
Objective: To describe the nutrition status and analyze the predictors among hemodialysis patients.
Methods: This study was conducted in a regional teaching hospital and 155 subjects who underwent dialysis three times a week were recruited. Descriptive statistics, correlation analysis, and hierarchical regression analysis were conducted on the demographic characteristics, dialysis conditions, and nutrition of the patients.
Results: 51.8% subjects were female, mean age was 64.10±13.28 years, and dialysis period was 6.00±4.86 years. For nutrition, mean albumin was 3.81±0.36 and 14.8% subjects experienced malnutrition (albumin < 3.5). Current employment was determined to be a significant predictor for albumin in hierarchical regression analysis, and explained 8.3% of all variances.
Conclusions/Application: 14.8% of the HD patients experienced malnutrition. The unemployed had higher rate of malnutrition, and most of the unemployed were the elderly. The researcher therefore proposes nutrition education for the elderly to increase their albumin level. If National Health Insurance can provide a reimbursement model based on quality-of-care similar to that for diabetes this may improve nutrition management among patients.