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研究生:吳佩瑜
研究生(外文):Wu, Pei-Yu
論文名稱:完整營養補充劑對於血液透析患者營養及生理狀況之影響
論文名稱(外文):Effects of complete nutritional supplement on nutritional and physiological status in hemodialysis patients
指導教授:謝明哲謝明哲引用關係楊淑惠楊淑惠引用關係
指導教授(外文):Shieh, Ming-JerYang, Shwu-Huey Sherry
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:保健營養學系
學門:醫藥衛生學門
學類:營養學類
論文種類:學術論文
論文出版年:2005
畢業學年度:93
語文別:中文
論文頁數:110
中文關鍵詞:血液透析口服補充劑營養不良生理狀況
外文關鍵詞:complete nutritional supplementhemodialysisnutritional status
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The present study was designed to evaluate the effect of complete nutritional supplement on selected nutritional and physiological variables in hemodialysis (HD) patients. Nineteen adult HD patients were on regular three times weekly HD for at least 3 months. Patients were followed for a 1-month baseline period, this was before an intervention period, during which, patients were asked to incorporate 100 g of complete nutritional supplement (providing 460 kcal and 18 g protein) daily for 1 month. Patients were reevaluated at third months. A 4 days dietary record was performed over baseline and intervention period. The main outcome measures including anthropometry, blood data, dietary intake, Kt/V, subjective scoring for appetite, and tolerance to supplement were obtained during the 3-month period. Patients incorporated mean 67g complete nutritional supplement over intervention period. This resulted in the energy intake rose to 30 kcal/kg body weight/day (P < 0.05). Following administration of complete nutritional supplement, there were significant increases in concentrations of serum total protein, transferrin, blood urea nitrogen and body fat (P < 0.05). Kt/V, subjective scoring for appetite, the concentrations of blood bicarbonate, and neutrophile count did not change during the study period. Complete nutritional supplement was shown to bring about a significant improvement in some selected nutritional markers such as serum total protein, transferrin, blood urea nitrogen and body fat in chronic HD patients, and does not effect the physiological variables of patients.
The present study was designed to evaluate the effect of complete nutritional supplement on selected nutritional and physiological variables in hemodialysis (HD) patients. Nineteen adult HD patients were on regular three times weekly HD for at least 3 months. Patients were followed for a 1-month baseline period, this was before an intervention period, during which, patients were asked to incorporate 100 g of complete nutritional supplement (providing 460 kcal and 18 g protein) daily for 1 month. Patients were reevaluated at third months. A 4 days dietary record was performed over baseline and intervention period. The main outcome measures including anthropometry, blood data, dietary intake, Kt/V, subjective scoring for appetite, and tolerance to supplement were obtained during the 3-month period. Patients incorporated mean 67g complete nutritional supplement over intervention period. This resulted in the energy intake rose to 30 kcal/kg body weight/day (P < 0.05). Following administration of complete nutritional supplement, there were significant increases in concentrations of serum total protein, transferrin, blood urea nitrogen and body fat (P < 0.05). Kt/V, subjective scoring for appetite, the concentrations of blood bicarbonate, and neutrophile count did not change during the study period. Complete nutritional supplement was shown to bring about a significant improvement in some selected nutritional markers such as serum total protein, transferrin, blood urea nitrogen and body fat in chronic HD patients, and does not effect the physiological variables of patients.
目 錄
頁數
摘 要……………………………………………………………………….Ⅰ
英文摘要…………………………………………………………………….Ⅱ
致 謝……………………………………………………………………….Ⅲ
目 錄……………………………………………………………………….Ⅳ
圖目錄……………………………………………………………………….Ⅵ
表目錄……………………………………………………………………….Ⅶ
附錄目錄…………………………………………………………………….Ⅷ
第一章 緒論………………………………………………………………….1
第二章 文獻回顧…………………………………………………………….3
第一節 末期腎臟疾病及透析治療現況…………………………………………...3
第二節 血液透析患者營養狀況…………………………………………………...5
第三節 血液透析患者飲食攝取情況…………………………………………….15
第四節 改善血液透析患者營養狀況方法……………………………………….18
第五節 血液透析患者與口服補充劑…………………………………………….19
第六節 完整營養補充劑營養素成份與血液透析患者生理狀況……………….22
第三章 材料與方法……………………………………...…………………25
第一節 研究架構………………………………………………………………….25
第二節 研究對象………………………………………………………………….28
第三節 研究設計………………………………………………………………….30
第四節 完整營養補充劑………………………………………………………….30
第五節 樣品收集與處理………………………………………………………….34
第六節 分析項目………………………………………………………………….34
第七節 分析方法………………………………………………………………….36
第八節 膳食調查………………………………………………………………….46
第九節 統計方法………………………………………………………………….48
第四章 結果…………………………………………………...……………49
第一節 受試者基本資料………………………………………………………….49
第二節 補充劑攝取狀況……………………………………………………..…...50
第三節 飲食攝取量…………………………………………………………...…..50
第四節 受試者體位測量及全面性主觀營養評估…………………………...…..52
第五節 血液指標……………………………………………………………...…..54
第六節 食慾……………………………………………………………………….58
第七節 血液透析前收縮壓及舒張壓…………………………………………….59
第八節 腸胃道功能……………………………………………………………….60
第五章 討論…………………...…………………………………………....63
第一節 探討受試者營養不良情形……………………………………………….63
第二節 探討受試者飲食攝取情形……………………………………………….63
第三節 探討受試者乾體重、肌肉及體脂肪…………………………………….67
第四節 探討受試者營養相關血液指標………………………………………….70
第五節 完整營養補充劑對於中/高度營養不良危險率組及低度營養不良危險率組受試者營養狀況影響………………………………………………….74
第六節 探討受試者生理狀況…………………………………………………….74
第七節 探討其他影響受試者營養狀況因子…………………………………….76
第六章 結論…………………………………………………...……………77
第七章 參考文獻……………………………………………...……………78

圖目錄
頁數
圖一、研究目的……………………………………………………………………………2
圖二、營養及生理狀況指標……………………………………………………………..25
圖三、影響營養狀況及血漿蛋白質因子………………………………………………..26
圖四、整個試驗架構……………………………………………………………………..27
圖五、每100克完整營養補充劑提供礦物質及維生素量符合營養素參考建議量(Dietary Reference Intakes, DRIs)百分比……………………………….……..33

表目錄
頁數
表一、完整營養補充劑之營養組成……………………………………………………..32
表二、所有受試者基本資料……………………………………………………………..89
表三、所有受試者於研究第0個月及第1個月飲食攝取量…………………………..90
表四、所有受試者於研究第0個月及第1個月之水、膳食纖維、維生素與礦物質攝取量…………………………………………………………………………………..91
表五、67克完整營養補充劑提供營養素與所有受試者實際飲食增加量之比較. …...92
表六、所有受試者體位測量、食慾、主觀性全面營養評估及血壓值……….……….93
表七、所有受試者研究期間血液檢測值………………………………………………..94
表八、所有受試者研究期間其他血液值…………………………………………....…..95
表九、低度營養不良危險率組及中/高度營養不良危險率組受試者基本資料……….96
表十、中/高度營養不良危險率組受試者第0個月及第1個月飲食攝取量………….97
表十一、中/高度營養不良危險率組受試者體位測量、食慾、全面性主觀營養評估及血壓……………………………………………...………………………………98
表十二、中/高度營養不良危險率組受試者研究期間血液值………………………….99
表十三、低度營養不良危險率組受試者於研究第0個月及第1個月飲食攝取量…100
表十四、低度營養不良危險率受試者體位測量、食慾、主觀性全面營養評估及血壓值….………………………………...………………………………………….101
表十五、低度營養不良危險率組受試者於研究期間血液檢測值……………………102
表十六、完整營養補充劑對於所有受試者排便次數影響……………………………103
表十七、測量身體組成與未測量身體組成受試者之基本資料………………………104
表十八、測量身體組成與未測量身體組成受試者之間透析前血清肌酸酐濃度比較.105
表十九、測量身體組成與未測量身體組成受試者之間乾體重及身體質量指數比較.106
表二十、攝取一個月口服完整營養補充劑對於受試者飲食及營養狀況影響………..61
表二十一、攝取一個月口服完整營養補充劑對於受試者生理狀況影響……………..62


附錄目錄
頁數
附錄一、完整營養補充劑攝取量及糞便排泄情形記錄表……………………………107
附錄二、食慾及飲食評估工具…………………………………………………………108
附錄三、主觀性全面營養評估表格……………………………………………………109
附錄四、飲食記錄單……………………………………………………………………110
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