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研究生:林淑湄
研究生(外文):Shu - Mei
論文名稱:熱量調整對長期使用呼吸器病人之影響
論文名稱(外文):Effect of regulating energy requirement on long term care of ventilated patients
指導教授:劉凱莉劉凱莉引用關係
指導教授(外文):Kai-Li Liu
學位類別:碩士
校院名稱:中山醫學大學
系所名稱:營養學系碩士班
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:2011
畢業學年度:99
語文別:中文
論文頁數:102
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本研究主要的目的是探討調整長期使用呼吸器的病患之熱量,使體重過輕(身體質量指數, body mass index; BMI≦19.9 kg/m2)或過重(BMI>23 kg/m2)病患達正常身體質量指數(BMI=20-22 kg/m2),對改善其營養狀況及呼吸器脫離之影響。研究對象為台中某地區醫院慢性呼吸照護病房共28位病患。以身體質量指數分為三組,患者使用鼻胃管灌食,對於體重過輕(BMI≦19.9 kg/m2)或過重(BMI>23 kg/m2)病患,藉以調整每日熱量攝取使其達到正常身體質量指數(BMI=20-22 kg/m2),研究介入為期六個月每個月收集病患客觀性營養評估、主觀性營養評估、營養狀況指標、生化檢驗、呼吸脫離指標。結果顯示介入前後體重過輕組(n =6)的體重並無明顯增加,但體重過重組(n=16)的體重明顯降低(47.9 ± 3.2 vs 49.0 ± 3.1, 65.0 ± 8.8 vs 62.3. ± 8.9 Kg),三組間白蛋白濃度的變化呈顯著差異。營養評估方法迷你營養評估表、病人主觀整體評估表、老人營養風險指標顯著改善體重過輕組的營養狀況。臨床營養師對於長期使用呼吸器患者準確的熱量供應並配合營養評估,對患者有正面的幫助,預期可減少醫療費用的支出與早日脫離呼吸器。

The main purpose of this study was to explore the effect of adjusting adnormal body mass in dext (BMI) to normal BMI on nutritional status and weaning efficacy in the long-term on ventilator patients. A total of 28 the long-term on ventilator patients from a regional hospital in Taichung chronic respiratory care ward divided by body mass index into three groups; underweight (BMI ≦ 19.9 kg/m2), overweight (BMI> 23 kg/m2) patients and normal body mass index (BMI = 20-22 kg/m2). In order to achieve normal BMI, the daily caloric intakes of patients with nasogastric tube feeding for underweight (BMI ≦ 19.9 kg/m2) or overweight (BMI> 23 kg/m2) patients were modifyied for six months. During the experiment period, atheropomotric nutrition assessment, subjective nutritional assessment, nutritional status indicators, biochemical tests and breathing from the index were monitored for every month. During the experimental period, the underweight group (n=6) did not significantly increase the weight but in the overweight group (n = 16) significantly reduced body weight (47.9 ± 3.2 vs 49.0 ± 3.1, 65.0 ± 8.8 vs 62.3. ± 8.9 Kg, P < 0.05). After six month intervention, blood albumin concentrations, in all three experimental groups were no significant change. Nutritional assessments such as mini nutritional assessment, subjective global assessment, geriatric nutritional risk index were significantly improved in underweight group. There is no significant difference in weaning efficacy among three experiment groups during the six month experiment period. In conclusion, nutrition intervention for long-term ventilator patients with modifying daily calory intake has a benefit in improvement of nutrition status.

目錄
誌 謝 II
中文摘要 I
Abstract II
縮寫對照表 IV
目錄 1
表目錄 3
圖目錄 4
附錄 6
第一章、前言 7
第二章、文獻探討 11
第一節、呼吸器使用序論 11
第二節、營養支持對呼吸系統的影響 14
第三節、體重對於使用呼吸器病患的影響 18
第四節、使用呼吸器病患的營養評估指標 20
第五節、呼吸器脫離指標 23
第三章、研究目的 25
第四章、研究對象與方法 26
第一節、受試者條件 26
第二節、研究概念架構 28
第三節、研究流程 29
第四節、資料收集與分析 30
第五節、統計方法 48
第六節、研究對象之權益保護 50
第五章、研究結果 51
第一節、研究對象之基本屬性 51
第二節、熱量介入後之能量攝取與營養狀況 58
第三節、熱量介入前後測量變項之變化 64
第六章、討論 78
第七章、結論與建議 84
第一節、結論 84
第二節、研究限制與建議 85
參考文獻 86



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