長時期常規血液透析對尿毒症病患營養狀況的影響

Effect of Long-term Regular Hemodialysis on Nutritional Status in Patients with Uremia

本研究的目的在探討尿毒症病患接受長時期規則血液透析治療對營養狀況的影響。研究對象為行政院衛生署新竹醫院血液透析室病人55名，依接受血液透析治療期間不同，分為三組：第一組為短期組，接受血液透析治療1-8個月，第二組為中期組，接受血液透析治療9-69個月，第三組為長期組，接受血液透析治療超過70個月，比較三組營養評估指標的差異。結果顯示：未接受透析治療前的身體質量指數（24.8±3.7）與現在的身體質量指數（22.1±3.6）有顯著差異（P<0.001），飲食評估長期組每天平均攝取熱量（31.7±8.0大卡／公斤）顯著大於短期組（28.5±7.3大卡／公斤）和中期組（24.3±5.3大卡／公斤）（P=0.024）。其餘人體測量值（上臂圍、三頭肌皮脂厚度、上臂肌肉圍、體脂肪百分比、瘦肉組織百分比）、生化檢驗值（血清白蛋白、總蛋白、膽固醇、血紅素、血球容積、淋巴球總數）、飲食蛋白質攝取量、生理功能（手部握力強度）、適當透析指標三組均無顯著差異，但各組上臂肌肉圍、手部握力強度平均值均低於參考值，平均熱量、蛋白質攝取低於建議量。結論：尿毒症病患的營養狀況，不因接受血液透析治療時期不同而有顯著差異，但普遍存在體組織消耗、熱量、蛋白質攝取不足、生理功能狀況減弱等營養問題，需要積極的營養介入，攝取足夠的營養素，改善營養狀況。

Fifty five uremic patients were studied to evaluate the duration of regular hemodialysistreatment affects their nutritional status. According to the duration of hemodialysis treatment patientswere divided into three groups: short-term hemodialysis （ ST-HD, 1-8 months） , mid-term hemodialysis（ MT-HD, 9-69 months） , and long-term hemodialysis（ LT-HD, more than 70-months） . We compared thenutritional assessment parameters among 3 groups. The results revealed that body mass index（ BMI）of usual body weight without hemodialysis treatment （24.8±3.7） were significantly higher than BMI ofcurrent dry weight （ 22.1± 3.6） in all patients（ P＜ 0.001） . The intake of calorie in LT-HD group （ 31.7± 8.0 Kcal/kg） was higher than ST-HD group（ 28.5± 7.3 Kcal/kg） and MT-HD group（ 24.3± 5.3 Kcal/kg） significantly （ P=0.024） . Mid-arm circumference, tricep skinfold, mid-arm muscle circumference,percentage of body fat and lean body mass, laboratory data（ serum albumin, total protein, cholesterol,hemoglobin, hemotocrit, total lymphocyte count） , physiological function（ hand grip strength） , proteinintake, and adequate dialysis parameters showed no differences among 3 groups. Average mid-armmuscle circumference and hand grip strength were under the reference value. Protein and calorie intakewere lower than recommendation. The results indicate that nutritional status of uremic patients werenot affected by variance duration of regular hemodialysis treatment , but diminished body protein store,protein and calorie intake, physiological function were widespread in hemodialysis patients, so thatnutrition intervention is vital to achieve nutritional status improvement.