臺灣博碩士論文加值系統

臺灣洗腎人口目前居亞洲之冠，營養治療在腎臟保健計劃中亦是重要的一環。本研究的目的是為探討一年兩次的飲食指導介入對於慢性腎臟疾病(CKD, Chronic kidney disease)患者體重、生化數值、熱量及蛋白質的攝取是否有正向的助益。研究方法：由秀傳醫院腎臟科門診隨機篩機101位慢性腎臟病患者，給予一年至少兩次的飲食指導衛教，並評估患者的體重、生化數值及熱量、蛋白質攝取前後之間的變化比較，並再進行相關性迴歸性分析其因子間的相關性是否有顯著性差異。結果：所篩選的慢性腎臟病患者以61-70歲人口最多，佔了35.6% ，其中高血壓及糖尿病患者所佔比例最多。在對慢性腎臟疾病患者做營養介入後發現白蛋白、尿素氮(BUN)、肌酸酐(Cr.)、血紅素(Hb)、尿酸、三酸甘油酯、膽固醇、血磷離子及飲食中蛋白質的攝取在營養介入後呈現顯著性的差異(p<0.001)；尿素氮(BUN)、肌酸酐(Cr.)、磷離子及MDRD-GFR等因子經迴歸性分析後發現它們有著顯著性的線性相關，將尿素氮、肌酐酸及磷離子與MDRD-GFR比較發現其線性關係存在著明顯的負相關(p<0.001)；而尿素氮與肌酐酸之間的線性關係顯示正相關性。統計方法：pair t-test及regression analysis。結論：營養介入對慢性腎臟疾病患者是具有助益的。

It is a large population of patients with hemodialysis in Taiwan. Nutritional support is important for these patients.
This study was aimed to understand the effect of dietary guide twice per year upon nutritional status for these patients in Show-Chung hospital. Results showed after one-year interventional program, albumin, BUN, creatinine, hemoglobin, uric acid, TG, cholesterol, phosphorus and dietary protein were significantly changed (p<0.001), in which MDRD-GFR was negatively correlated with BUN, creatinine and phosphours (p<0.001). This study found that dietary guide for chronic kidney disease patients twice per year was beneficial.

總目次
中文摘要…………………………………………………..……..…Ⅰ
Abstract………………………………………………………..…... Ⅱ
第一章 緒論……………………………………..………………....1
第二章 文獻探討…………………………………………………..3
第一節 慢性腎臟疾病的定義…………………….…..…………...3
第二節 慢性腎臟疾病的盛行率……………………..……………3
第三節 慢性腎臟疾病的分期………………………..……………4
第四節 慢性腎臟疾病的惡化因子………………………………..6
第五節 慢性腎臟疾病的營養介入………………………………..9
第三章 研究目的………………………..………………...……….14
第四章 研究方法……………………………..…………………....15
第一節 研究設計…………………………………..………...…….15
第二節 研究流程…………………………………….…………….15
第三節 統計分析………………………………….....…………….18
第五章 實驗結果…………………………………………………..19
第六章 討論………………………………………………………..30
第七章 總結………………………………………………………..33
第八章 參考文獻…………………………………………………..56
表目次
表1 受試者基本資料分析………………………………………35
表2 受試者各項數值前後結果總表……………………………36
表3 受試者各項數值前後結果一覽表…………………………37
表4 各項因子間具有顯著差異的線性關係表…………..……..38
圖目次
圖1 性別分佈圖…………………………………………………..39
圖2 年齡分佈圖…………………………………………………..39
圖3 MDRD-GFR分期分佈圖……………………...…………….40
圖4 系統疾病分佈圖……………………………………………..40
圖5 體重變化比較圖……………………………………………..41
圖6 收縮壓變化比較圖…………………………………………..41
圖7 舒張壓變化比較圖…………………………………………..42
圖8 MDRD-GFR變化比較圖……………………………………42
圖9 血紅素(Hb)變化比較圖……………………………………...43
圖10血球容積(Hct)變化比較圖……………………………...……43
圖11尿素氮(BUN)變化比較圖………………………………...…..44
圖12肌酐酸(Cr.)變化比較圖……………………………………….44
圖13尿酸(UA)變化比較圖…………………………………………45
圖14鈉離子(Na)變化比較圖……………………………………….45
圖15鉀離子(K)變化比較圖………………………………...………46
圖16磷離子(P)變化比較圖………………………………...……….46
圖17鈣離子(Ca)變化比較圖…………………..…………....………47
圖18 白蛋白(Alb)變化比較圖………………………………………47
圖19 膽固醇(Chol) 變化比較圖…………………………………..48
圖20 三酸甘油酯(TG) 變化比較圖……………………………….48
圖21空腹血糖(AC)變化比較圖……………………………………49
圖22糖化血色素(HbA1c)變化比較圖……………………………..49
圖23熱量攝取變化比較圖………………………………………….50
圖24蛋白質攝取變化比較圖……………………………………….50
圖25實際蛋白質攝取量與建議蛋白質攝取量變化比較圖……….51
圖26 MDRD-GFR與尿素氮(BUN)的線性關係………………....…51
圖27 MDRD-GFR與肌酐酸(Cr.)的線性關係……………….…...…52
圖28 MDRD-GFR與磷離子(P)的線性關係…………………...……52
圖29尿素氮(BUN)與肌酐酸(Cr.)的線性關係…………………...….53
圖30尿素氮(BUN)與磷離子(P)的線性關係…………………..…….53
圖31尿素氮與CKD-stage線性關……………………………………54
圖32血糖與糖化血色素的線性關係………………………………...54
圖33血紅素與白蛋白的線性關係…………………………………...55
圖34血比容與白蛋白的線性關係圖………………………………...55

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