臺灣博碩士論文加值系統

目的--本研究目的在於 (一) 評量及驗證原“簡易營養評估量表＂或其台灣修
訂版運用於評估台灣中風患者之功能性，以使其更適合台灣中風患者之使
用，及 (二) 以簡易營養評估量表評量台灣腦中風患者之營養風險及分析其相
關因素。
方法--本研究採立意取樣，以台北市萬華長期照護中心收案滿一個月以上，年
滿18 歲，經醫師診斷確認為非暫時性腦缺血 (transient ischemic attack, TIA)
之中風患者，沒有罹患精神疾病，可以自已溝通，或可由家屬或照護者協助
而溝通，經說明後同意參加本研究並簽同意書之個案為研究對象，進行個別
問卷面訪。本研究有效訪談74 個案 (男44，女30)。收集人口學，社會，經
濟，健康照護與病症特性、簡易智能量表、巴氏量表、簡易營養評估量表及
該量表在身體質量指數、臂中圍和小腿圍等指標做不同分切點及重新配分之
兩修訂版等之評估資料。採用SPSS/Windows 10.0 統計套裝軟體進行描述性及
推論性統計分析。
結果--研究對象平均75 歲，平均罹病時間為73 (SD=82.76) 月。依原量表，
24.3%被評估為營養不良，56.8%具營養不良風險，18.9%為營養良好。依第一
修訂， 13.5%被評估為營養不良，63.5%具營養不良風險，23.0%為營養良好。
再依第二修訂，18.9%被評估為營養不良，56.8%具營養不良風險，24.3%為營
養良好。日常生活功能平均為38.4±32.6 分。小腿圍及臂中圍與三版本量表
MNA 之總分均呈顯著正相關。迴歸分析顯示日常生活功能、認知功能及疾病
數均與MNA 三版本之總分呈顯著關聯性,尤其第二修正版本最為顯著。
結論--本研究結果顯示，台北市長期照護中心收案的中風患者約四分之三營養
不良或具營養風險，只四分之一為營養良好。此比率較一般居家老人為高 (一
般居家老人為1-3%)。如本研究再包括認知困難者，則營養不良之比率將更
高。經修訂之MNA 量表，尤其修訂二，較原量表有較佳的功能性與判別能力，
且不需要使用BMI 值，因此使用更為簡易，更適合照護者或醫護人員用來篩
選中風患者的營養風險。中風患者定期的營養風險評估並給予即時的介入可
減少營養不良之發生。這些結果將有助於長照機構規劃中風患者之照護計
畫。有效的介入及良好的照護政策不但可提升患者之生活品質亦可節省照護
及醫療開支。

Objective: The objective of this study was to examine the functionality of a
modified Mini Nutritional Assessment for assessing the nutritional status of stroke
patients in Taiwan.
Design and sampling: The study employed a purposive sampling design by
involving the patient pool of Wen-Hua Stroke Patient Homecare Services of Taipei
City.
Subject criteria : To be eligible to participate in the study, the subject must be: (a)
confirmed stroke patients, (b) 40 y or older, (c) cognitively functional and be able
to communicate, (d) being admitted to the Center for at least one month and (e)
willing to sign an informed study consent.
Measurements: An in-home in-person interview was conducted on each patient
with a structured questionnaire which included personal information, and the
MMSE, Barthel index and MNA scales. Each subject’s nutritional status was
assessed according to the original or two modified version of the MNA. The first
modification replaced population-specific BMI, Mid-arm circumference (MAC)
and Calf circumference (CC) cut-points for values specified in the original MNA.
The second modification eliminated the question of BMI and distributed its scores
to MAC and CC. Results were analkyzed by correlation analysis and linear
regression analysis to determine the association of the nutritional status with the
major functional indicators.
Results: The study showed that 24.3% of patients were malnourished, 56.8% were
at risk of malnutrition and18.9% were well nourished according to the original
MNA; 13.5% of patients were malnourished, 63.5% were at risk of malnutrition
and 23% were well nourished according to the modified MNA version I ; 18.9% of
patients were malnourished, 56.8% were at risk of malnutrition and 24.3% were
well nourished according to the modified MNA version II . MAC and CC showed
significant correlations with all three versions the MNA score, other
anthropometric parameters such as BMI, waist circumference and waist to hip ratio
showed no correlations with the MNA. The scores of MMSE and ADL showed
high correlations with the MNA-II scores. These results suggest that modified
MNA, especially MNA-II which does not involve BMI can be effectively used to
assess the nutritional risk status of stroke patients.
Conclusion: MNA-II, a modified version of the MNA without using BMI, can
effectively predict nutritional risk status of Taiwanese stroke patients. This
modified version can greatly improve the utility of the MNA since measuring
weight and height, especially for those living at home, is not an easy task for stroke
patients. The tool can be used to detect individuals at risk of malnutrition, enabling
timely intervention and healthcare cost.

第一章 緒論
第一節 研究動機與目的 1
第二章 文獻探討
第一節 中風患者或長照機構住民之營養不良盛行率 3
第二節 簡易營養評估量表的發展與應用 6
第三節 簡易營養評估量表應用於非白人族群可能發生之困難 8
第四節 修訂簡易營養評估量表用於台灣老人之概況 9
第三章 研究方法
第一節 研究設計及抽樣 10
第二節 研究對象收案標準 11
第三節 程序 12
第四節 調查訪談及資料收集 14
第五節 研究工具之效度評估 15
第六節 統計分析 16
第七節 倫理考量 17
第四章 結果
第一節 社會人口學與健康相關資料 18
第二節 認知功能 20
第三節 日常生活功能 21
第四節 營養評估 22
第五節 MNA 總分與各種體位指標之相關分析 24
第六節 影響MNA 總分之因素 25
i
第五章 討論
第一節 中風病人營養狀況 27
第二節 MNA 修訂版之功能 31
第三節 綜合討論 34
第四節 研究限制及建議 37
第五節 結論 38
參考文獻 39

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