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研究生:高上雅
研究生(外文):KAO SHANG-YA
論文名稱:比較機構住民使用鼻胃管與胃造口灌食之營養狀況
論文名稱(外文):To Compare Nutritional Status on Institutionalized Elders with Nasogastric Tube or Percutaneous Endoscopic Gastrostomy
指導教授:何美瑤何美瑤引用關係
指導教授(外文):Ho Mei-Yao
學位類別:碩士
校院名稱:美和科技大學
系所名稱:健康照護研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2016
畢業學年度:104
語文別:中文
論文頁數:105
中文關鍵詞:胃造口鼻胃管管灌營養狀況營養狀況評估
外文關鍵詞:Gastrostomynasogastric tubetube feedingnutritional statusnutritional status assessment
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背景:人口老化的急遽上升、疾病型態慢性化與複雜化、照護時間長期化等,以致長期照護需求與日俱增,而在老年問題方面老人的營養不良之盛行率為5~10%,在長期照護機構或慢性病房則盛行率則高達60%。長照機構中吞嚥困難住民普遍留置鼻胃管(NG Tube),因此多半伴隨口腔牙齒衛生不佳、吸收消化不佳、嗅覺或味覺功能障礙、老化引起之胃酸分泌缺乏症等問題,經皮內視鏡胃造口術(PEG)則為替代長期鼻胃管留置所伴隨的障礙或症狀不適,故近年來大力推廣。
目的:本研究目的旨在探討鼻胃管灌食與經皮內視鏡胃造口住民間之營養狀況變化,依變項包括體重、BMI、生化值等指標的變化。
方法:本研究為縱貫性與回溯性研究設計,採立意取樣法,採用「迷你營養評估量表」、「巴氏量表」及加入生化測量等資料,調查屏東地區某三家老人養護機構具鼻胃管放置與行胃造口術者共76位研究對象。
結果:此研究中發現實施管灌前MNA「總計」具顯著差異(P = 0.020*)、飯前血糖具顯著差異(P = 0.049*);鼻胃管與胃造口者在管灌後白蛋白吸收具顯著差異 (P = 0.003*);兩組比較第1,3,6,9個月之體重與身體質量指數皆無顯著差異(P>0.05),因兩者組內比較結果「體重」在第3~第6個月、第3~9個月間體重各具顯著差異(P = 0.022*/ 0.040*),鼻胃管使用者其體重於1,3,6,9個月呈現下降趨勢,而胃造口使用者體重則有逐漸上升情形。
實務應用:本研究發現可供長期灌食者於管路放置後營養狀況變化,以提供住民選擇適合自己的營養攝取方式參考。

Background:Due to increasing aging population with chronic illness, and illness complicated, result into the demand for long-term care with prolong care period. The prevalence of malnutrition among elderly accounts for 5 to 10%, however, the prevalence is up to 60% in long-term facilities or chronic wards. Elderly who are with swallowing problems tend to insert Nasogastric tube (NG Tube) for feeding in long-term care institutions. However, most of them with a nasogastric tube are accompanied poor oral dental hygiene, poor digestion and absorption, smell or taste dysfunction, secretion deficiency disorders. The alternative option is percutaneous endoscopic gastrostomy (PEG) with the strength to replace discomfort of indwelling nasogastric tube.
Purpose:This study aimed to compare nutritional status on institutionalized elders with nasogastric tube or percutaneous endoscopic gastrostomy. Dependent variables included body weight, BMI, and biochemical parameters.
Methods:A Longitudinal and retrospective study design with purposive sampling was used. Research instrutment were included "Mini Nutritional Assessment Scale", "Barthel Index" and biochemical measurements. This survey was conducted in three elderly care facilities in Pingtung. A total of 76 subjects with either a NG tube or REG were recruited.
Results:There was a significant difference (P = 0.020 *) of MNA "Total score" between NG and PEC group before feeding. There was a significant difference (P = 0.049 *) blood sugar before meals.
There was a significant difference on serum albumin between NG and PEC group after implementation of feeding. Body weight and BMI were no significance during the 1st, 3rd, 6th, 9th month between NG and PEC group after implementation of feeding (P>0.05). Body weight was decreased compared with the change during 1st, 3rd, 6th, 9th month in NG feeding group. In comparison with PEG group, body weight was increased with the change during 1st, 3rd, 6th, 9th month.
Implications for practive:The results provide a long term nutritional status change for those whom need a NG or PEC feeding which served as a reference for institutionalized elders.
目錄
頁次
中文摘要 i
英文摘要 iii
誌 謝 v
目 錄 vi
圖表目錄 ix
第一章 緒論 1
第一節 研究背景、動機及重要性 1
第二節 研究目的 4
第三節 名詞解釋定義 4
第二章 文獻查證 6
第一節 老人營養不良 6
第二節 篩檢與評估 11
第三節 處置 23
第四節 胃造口(PEG)與鼻胃管(NG tube)比較 28

頁次
第三章 研究方法 30
第一節 研究設計 30
第二節 研究架構 31
第三節 研究假設 32
第四節 研究對象與資料來源 33
第五節 研究倫理 34
第六節 研究變項編碼 35
第七節 研究工具與其信效度 37
第八節 研究資料處理與統計分析 42
第四章 研究結果 44
第一節 研究樣本與鼻胃管(NG)、胃造口(PEG)灌食前基本屬性分析
44
第二節 鼻胃管(NG)與胃造口(PEG)灌食後,體重(BW)、身體質量指數(BMI) 與生化值數據分析 49
第三節 鼻胃管(NG)與胃造口(PEG)灌食個案之一年內的體重(BW)與身體質量指數(BMI)變化 51

頁次
第五章 討論 56
第一節 研究樣本與鼻胃管、胃造口灌食前基本屬性探討 56
第二節 鼻胃管與胃造口灌食後,體重、身體質量指數與生化值數據探討 59
第三節 鼻胃管與胃造口灌食個案之一年內的體重與身體質量指數變化探討 60
第六章 結論與建議 62
第一節 研究分析所得結論與建議 62
第二節 研究結果之應用 63
第三節 研究限制 64
參考文獻 65
附件一 IRB人體試驗委員會同意書
附件二 研究參與同意書(醫護版)
附件三 研究參與同意書(住民版)
附件四 台灣雀巢股份有限公司引用同意書
附件五 MNA迷你營養評估量表
附件六 巴氏量表

圖表目錄
頁次
圖2.2 Malnutrition Universall Screening Tool, MUST 13
表2.2 Admission nutrition screening tool, ANST 14
表2.3 外科胃造口術(SG)與經皮內視鏡胃造口術(PEG)比較 26
表2.4 胃造口(PEG)與鼻胃管(NG tube)比較 29
表3.6 研究變項編碼 35
表3.7.1迷你營養評估量表(MNA)之信度 39
表3.7.2日常生活功能量表(ADL)之Cronbach’s alpha值 41
表3.8 研究假說統計方法 43
表4.1 鼻胃管(NG)與胃造口(PEG)灌食前基本屬性分析 48
表4.2 鼻胃管(NG)與胃造口(PEG)灌食後,體重(BW)、身體質量指數(BMI) 與生化值數據分析 50
表4.3.1鼻胃管(NG)與胃造口(PEG)灌食個案之一年內的體重(BW)變化 54
表4.3.2鼻胃管(NG)與胃造口(PEG)灌食個案之一年內的身體質量指數(BMI)變化 54
圖4.3.1鼻胃管(NG)與胃造口(PEG)灌食個案之一年內的體重(BW)變化 55
圖4.3.2鼻胃管(NG)與胃造口(PEG)灌食個案之一年內的身體質量指數(BMI)變化 55


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彭巧珍(2011)‧老年人的營養需求‧於胡月娟總校閱,老人護理學(二版,151-192)‧新北市:新文京開發。﹝Peng, C.J. (2011). The nutritional needs of the elderly. In Y.J. Hwu (Ed.), Gerontological Nursing (2nd ed., pp. 151-192). New Taipei City, Taiwan, ROC: New Wun Ching Developmental.﹞
馮俞綾、鄭裕耀、李春松、白其卉、蔡宗志、張宜平、吳憲政(2014)‧大腸直腸癌病患營養篩檢工具之比較‧臺灣營養學會雜誌,39(1),11-19。﹝Feng, Y.L., Cheng, Y.Y., Lee, C.S., Bai, C.H., Tsai, T.C., Chang, Y.P., & Wu, H.C. (2014). Comparison of Nutritional Screening Tools for Patients with Colorectal Cancer. Nutritional Sciences Journal, 39(1), 11-19.﹞
葉莉莉(2008)‧經皮內視鏡胃造口─長期營養支持的較佳選擇‧長期照護雜誌,12(1),116-125。﹝Yeh, L.L. (2008). Percutaneous Endoscopic Gastrostomy-A Better Choice for Long-term Enteral Nutritional Support. The Journal of Long-term Care, 12(1), 116-125.﹞
葉莉莉、陳淑音、盧豐華、莊喬雄、陳清惠(2008)‧專業攜手合作推廣胃造口─長期管灌病人的較佳選擇‧長期照護雜誌,12(4),355-360。﹝Yeh, L.L., Chen, S.Y., Lu, F.H., Chuang, C.H., & Chen, C.H. (2008). Professional Collaboration to Enhance Percutaneous Endoscopic Gastrostomy Use: A Better Choice for Enteral Nutritio n. The Journal of Long-term Care, 12(4), 355-360.﹞
黎小娟、徐亞瑛(2006)‧蛋白質攝取在老年骨鬆性髖骨骨折術後的角色‧台灣老年醫學雜誌,2(2),70-81。﹝Li, H.J., & Shyu, Y.I. L. (2006). The Role of Dietary Protein for the Elderly with Osteoporotic Hip Fracture Postoperatively. Taiwan Geriatr Gerontol, 2(2), 70-81.﹞
劉茂森、蒲秀瑾(2006)‧經皮內視鏡胃造口術在老年人腸道餵食的角色‧台灣老年醫學雜誌,2(2),82-91。﹝Liu, M.S., & Pu, S.J. (2006). The Role of Percutaneous Endoscopic Gastrostomy (PEG) in the Enteral Feeding of the Elderly. Taiwan Geriatr Gerontol, 2(2), 82-91.﹞
劉錦茹、王馨羚(2010)‧臨床護理人員營養篩檢與評估的角色‧高雄護理雜誌,27(2),88-97。﹝Liu, C.J., & Wang, H.L. (2010). Nurse's Role of Nutritional Screening and Assessment in Hospital. The Kaohsiung Journal of Nursing, 27(2), 88-97.﹞
蔡淑美、李淑桂、洪郁雯、蔡婉蓉(2011)‧提昇護理人員執行鼻胃管留置病患相關衛教完整率‧中山醫學雜誌,22(1),129-139。﹝Tsai, S.M., Lee, S.K., Hung, Y.W., & Tsai, W.J. (2011). Promoting Nursing Staff's Complete Rate of Executing Relevant Health Education for Patients with Nasogastric Tube Retained. Chung Shan Medical Journal, 22(1), 129-139.﹞
盧美秀(2002)‧臨床醫護手冊(三版)‧台北市:華杏。﹝Lu, M.S. (2002). The Clinic manual of medicine and nursing (3rd ed.). Taipei City, Taiwan, ROC: Farseeing.﹞
賴明宏(2011)‧老人營養學(初版)‧新北市:威仕曼文化。﹝Lai, M.H. (2011). Geriatric Nutrition (1st ed.). New Taipei City, Taiwan, ROC: Wiseman Culture.﹞
賴聖如(2012)‧癌症營養‧取自http://www.ntuh.gov.tw/DD/education/1234/%E7%99%8C%E7%97%87%E7%87%9F%E9%A4%8A.pdf﹝Lai, S.R. (2012). Cancer Nutrition. Retrieved from http://www.ntuh.gov.tw/DD/education/1234/%E7%99%8C%E7%97%87%E7%87%9F%E9%A4%8A.pdf﹞
謝美玲、石明煌、楊福麟(2009)‧營養篩檢工具在臨床護理的應用‧志為護理,8(2),65-72。﹝Hsieh, M.L., Shyr, M.H., & Yang, F.L. (2009). The Application of Nutritional Screening Tools in Nursing Practice. Tzu Chi Nursing Journal, 8(2), 65-72.﹞
聯合醫事檢驗所(2011)‧生化學檢查:白蛋白(Albumin)‧取自http://www.ucl.com.tw/WebMaster/?section=83﹝Union Clinical Laboratory (2011). biochemical examinations : Albumin(Albumin). Retrieved from http:// www.ucl.com.tw/WebMaster/?section=83﹞
鍾蝶起、趙耿裕、林建志、李昭憲、楊燦(2009)‧長期照護醫事人力與照護需求研究(研究計畫編號DOH96-TD-M-113-053)‧屏東縣:美和技術學院。﹝Chung, T.C., Chao, K.Y., Lin, C.C., Lee, C.H., & Yang, T. (2009). Medical manpower of Long-term care and care for the needs study (Research Grant DOH96-TD-M-113-053). Ping Tung County, Taiwan, ROC: MeiHo University Meiho Junior College Of Nursing And Management.﹞
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1. 江文忍、林晏如、張家慧、陳筱瑀(2012)‧經皮內視鏡胃造口之介紹及其護理‧護理雜誌,59(4),94-98。doi: 10.6224/JN.59.4.94﹝Chiang, W.J., Lin, Y.J., Chang, C.H., & Chen, H.Y. (2012). Percutaneous Endoscopic Gastrostomy (PEG): Overview and Nursing Care. The Journal of Nursing, 59(4), 94-98. doi: 10.6
2. 李美慧、林麗嬋(2005)‧居家腸道管灌之營養評估與問題處置‧長期照護雜誌,9(2),183-192。﹝Lin, M.H., & Lin, L.C. (2005). Nutritional Assessment and Problems Management among Patients with Home Enteral Tube Feeding. The Journal of Long-Term Care, 9(2), 183-192.﹞
3. 吳亭瑤、陳惠滿(2009)‧一位腦幹中風導致吞嚥障礙患者之護理經驗‧志為護理,8(3),91-99。﹝Wu, T.Y., & Chen, H.M. (2009). Nursing Experience with a Patient with Dysphagia Caused by Brain Stem Infarction. Tzu Chi Nursing Journal, 8(3), 91-99.﹞
4. 林昭卿、莊照明、趙淑員、李春國(2008)‧長期照護機構住民功能性評估之研究‧弘光學報,(52),67-80。﹝Lin, C.C., Chuang, C.M., Chao, S.Y., & Li, C.G. (2008). A Study on Functional Assessment in Long-term Care Facility. Hiromitsu Journal, (52), 67-80. ﹞
5. 林韋君、袁素娟、黃秀梨(2010)‧營養狀況改變及護理‧領導護理,11(3),21-32。﹝Lin, W.C., Yuan, S.C., & Hwang, S.L. (2010). Nursing Care for a Patient with Altered Nutritional Status. Leadership Nursing, 11(3), 21-32.﹞
6. 林麗嬋、吳肖琪、蔡誾誾、張淑卿(2010)‧現行長期照護評估工具的問題與因應‧長期照護雜誌,14(3),255-265。﹝Li, L.C., Wu, S.C., Tsai, Y.Y., & Chang, S.C. (2010). Issues of Current Assessment Tool for Long-term Care in Taiwan. The Journal of Long term care, 14(3), 255-265.﹞
7. 施至遠、陳人豪(2008)‧老年人吞嚥障礙之評估與處置‧長期照護雜誌,12(4),337-346。﹝Shih, C.Y., & Chen, J.H. (2008). Evaluation and Management of Dysphagia in the Elderly. The Journal of Long-term Care, 12(4), 337-346.﹞
8. 馬志君、楊舒琴(2007)‧協助一位居家護理病人胃造瘻決策過程之經驗‧志為護理,6(4),123-132。﹝Ma, C.J., & Yang, S.C. (2007). Home Care Nursing Experience of the Decision Making Process for Percutaneous Endoscopic Gastrostomy. Tzu Chi Nursing Journal, 6(4), 123-132.﹞
9. 陳清惠(2004)‧老人營養狀況之評估‧護理雜誌,51(5),10-14。﹝Chen, C.H. (2004). Assessment of Nutritional Status in the Elderly. The Journal of Nursing, 51(5), 10-14.﹞
10. 陳淑芬、鄧素文(2010)‧台灣長期照護服務體系之發展‧護理雜誌,57(4),5-10。﹝Chen, S.F., & Teng, S.W. (2010). The Development of the Long-Term Care Service System in Taiwan. The Journal of Nursing, 57(4), 5-10.﹞
11. 黃彥皓、陳鼎達(2006)‧進食困難病人的營養評估與餵食管的選擇‧基層醫學,21(4),76-80。﹝Huang, Y.H., & Chan, T.T. (2006). The difficulty eating patient's nutritional assessment and the choice of feeding tube. Primary Medical Care & Family Medicine, 21(4), 76-80.﹞
12. 馮俞綾、鄭裕耀、李春松、白其卉、蔡宗志、張宜平、吳憲政(2014)‧大腸直腸癌病患營養篩檢工具之比較‧臺灣營養學會雜誌,39(1),11-19。﹝Feng, Y.L., Cheng, Y.Y., Lee, C.S., Bai, C.H., Tsai, T.C., Chang, Y.P., & Wu, H.C. (2014). Comparison of Nutritional Screening Tools for Patients with Colorectal Cancer. Nutritional
13. 葉莉莉(2008)‧經皮內視鏡胃造口─長期營養支持的較佳選擇‧長期照護雜誌,12(1),116-125。﹝Yeh, L.L. (2008). Percutaneous Endoscopic Gastrostomy-A Better Choice for Long-term Enteral Nutritional Support. The Journal of Long-term Care, 12(1), 116-125.﹞
14. 葉莉莉、陳淑音、盧豐華、莊喬雄、陳清惠(2008)‧專業攜手合作推廣胃造口─長期管灌病人的較佳選擇‧長期照護雜誌,12(4),355-360。﹝Yeh, L.L., Chen, S.Y., Lu, F.H., Chuang, C.H., & Chen, C.H. (2008). Professional Collaboration to Enhance Percutaneous Endoscopic Gastrostomy Use: A Better Choice for Enteral Nutritio
15. 謝美玲、石明煌、楊福麟(2009)‧營養篩檢工具在臨床護理的應用‧志為護理,8(2),65-72。﹝Hsieh, M.L., Shyr, M.H., & Yang, F.L. (2009). The Application of Nutritional Screening Tools in Nursing Practice. Tzu Chi Nursing Journal, 8(2), 65-72.﹞