臺灣博碩士論文加值系統

本研究主要的目的是探討長期使用管灌病患，包含使用鼻胃管(nasogastric tube，簡稱NG)及經皮內視鏡胃造口(percutaneous endoscopic gastrostomy，簡稱PEG)者之營養狀況及其影響死亡率的相關因素，藉由本研究的結果提供專業人員、病患及家屬在臨床上選擇管路餵食方式的依據及參考。
收集北部某醫學中心276位長期使用管灌進食（大於一個月）病患為研究樣本，其中使用NG者有156位病患，PEG者有120位，藉由病歷回溯的方式，分析其營養狀況如Albumin、Hemoglobin、BMI及罹病綜合指標（Charlson comobidity index，簡稱CCI）等，並自2000至2005年，追蹤其五年之死亡率。
結果發現，兩組病患之營養狀況以PEG組較佳，兩組Albumin之平均值為2.9±1.1mg/dl（NG組為2.7±1.2g/dl，PEG組為3.2±1.0g/dl，P < 0.05），而營養不良者（albumin＜3.5mg/dl）占72.1％，但兩組之CCI在統計上並無明顯差異。進一步以Kaplan-Meier分析各個相關因素與死亡率之關係，結果發現放置管路性質與兩組之死亡率在統計上並無顯著差異（其五年總死亡率為38.04％，NG組死亡率為39.74%，PEG 35.83%； P＞0.05），以Cox Regression分析得知影響病患之死亡率，以年齡、CCI、Albumin及Hemoglobin統計上有顯著意義。
因此本研究顯示長期使用管灌餵食者，無法以放置管路性質預測其死亡率，而使用PEG組營養狀況之生化數值（Albumin及Hemoglobin）皆較鼻胃管組者佳，且年齡、Charlson comobidity index、Albumin、Hemoglobin對於死亡率有顯著之預測能力，值得作為未來政策規劃參考及相關研究之參考。

This research was mainly to investigate the nutritional status and other related factors among the patients receiving the long-term of tube feeding, including nasogastric tube（NG）and percutaneous endoscopic gastrostomy（PEG）. By the chart review in a medical center in the North Taiwan from 2000 to 2005, there were 276 people（NG=156，PEG=120） recruited using tube feeding more than a month. Analyzing the nutritional status as albumin, hemoglobin, BMI, and a morbidity index (using the Charlson comorbidity index), we found that patients with PEG were in better nutritional status. Besides, there are 72 percent of all patients suffering from malnutrition condition, which was defined by albumin less than 3.5g/dl. The mean albumin levels in the whole group was 2.9±1.1mg/dl, and 2.7±1.2g/dl, 3.2±1.0g/dl for NG tube and PEG group, respectively. There was no statistically significant difference between two groups.
Furthermore, we used Kaplan Meier to analyze the relationship between mortality and its related factors. We found that there was no significant difference between the type of tube feeding and the mortality in both groups（total mortality38.04％，NG group is39.74%,PEG group is 35.83%；P>0.05）. Using Cox regression analysis, we found that patients’ age, Charlson comobidity index, albumin and hemoglobin were significantly associated with mortality. In conclusion, we found that the biochemical data was better in the patient with PEG than NG. Besides, the mortality can be predicted by patients’ age, Charlson comorbidity index, and hemoglobin.Our study results can be applied as the policy–making reference of long-term care in the future.

第一章　緒論
第一節　研究背景與動機 ............................................................................ 1
第二節　研究目的 ........................................................................................ 5
第二章　文獻查證
第一節　長期的營養支持之重要性 ................................................ ........... 6
第二節　鼻胃管之適應症及併發症 ............................................................ 9
第三節　經皮內視鏡胃造口之適應症、併發症、移除率及死亡率......... 12
第四節　存活相關因子之探討 .................................................................... 20
第三章　研究方法
第一節　研究架構 ........................................................................................ 24
第二節　名詞界定 ........................................................................................ 25
第三節　研究場所及對象 ............................................................................
26
第四節　研究工具及其信效度 .................................................................... 27
第五節　研究步驟 ........................................................................................ 30
第六節　統計分析 ........................................................................................ 31
第四章　研究結果
第一節　經皮內視鏡胃造口及鼻胃管之基本人口學................................
病患之基本屬性
........................................................ 33
第二節　經皮內視鏡胃造口及鼻胃管生活功能之情形................................
............................................................ 34
第三節　經皮內視鏡胃造口及鼻胃管Charlson comobidity index積分情形
................................................... 35
第四節　經皮內視鏡胃造口及鼻胃管死亡率及其相關因素
.................................. 36
第五章　討論............................................................................ ......................... ... 40
第六章　結論、限制、後續研究方向.................................. ......................... ...
48
參考文獻
66
相關表格與問卷
表一：基本人口學資料 ................................................................................. 51
表二：生活功能之情形 .................................................................................
52
表三：GCS之情形 ..................................................................................... 52
表四: 疾病分佈情形..................................................................................... 53
表五：兩組管路放置之情形 .........................................................................
54
表六：查閱身高體重之結果 ...................................................................
54
表七：兩組壓瘡之情形 .................................................................................
54
表八：兩組之死亡率情形..........................................................................
55
表九：血液生化數值 ..................................................................................... 55
表十：重要因素迴歸分析.............................................................. ................. 56
圖一：研究架構.............................................................. .............. ................. 25
圖二：兩組管路與死亡率之關係（Kaplan-Meier）.................................... ... 57
圖三：年齡與死亡率之關係（Kaplan-Meier）.................................... ... 57
圖四：性別與死亡率之關係（Kaplan-Meier）..................................... ... 58
圖五：失智症與死亡率之關係（Kaplan-Meier）..................................... 58
圖六：腦血管疾病與死亡率之關係（Kaplan-Meier）..................................... 59
圖七：Albumin與死亡率之關係（Kaplan-Meier）.....................................
59
圖八：Hemoglobin與死亡率之關係（Kaplan-Meier）..................................... 60
圖九：壓瘡與死亡率之關係（Kaplan-Meier）............................................. 60
圖十：Charlson comobidity index與死亡率之關係（Kaplan-Meier）....... 61
參考文獻 62
附錄 65
附錄一：收案問卷 ........................................................................................ 62
附錄二：申請收案機構同意書 .................................................................... 65

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