臺灣博碩士論文加值系統

國內長期照護機構因營養師欠缺，全國將近8 萬五千床的機構老人，能由專業營養師介入評估的老人照護比例相對低，在專業人員不足且需求性大的狀況下，現階段尋求一個簡易的老人營養篩檢評估工具以輔助營養師作為營養照護順序的指標提升營養照護的效率及品質是迫切需要的。故針對長期照護機構臨床常見之營養評估工具血清白蛋白(Albumine, Alb) 、身體質量指數(body mass index, BMI)、體重下降比例及老人營養風險指標(Geriatric nutritional risk index, GNRI) ，來探討何者較適合用來評估此族群之營養狀況，以利營養師臨床之應用。共募集122 位來自北、中、南三家長期照護機構老人，發現GNRI 與Alb 相較於其他評估法在「正常組」及「營養不良危險組」中與住院天數具有顯著組間差異性並呈現負相關。以ROC curve 分析，GNRI 相較於Alb 及BMI 具有較高之效度。更進一步以GNRI 之四個層級進行比較，結果顯示GNRI 之層級差異與住民之體重、白蛋白及一、三及六個月的住院天數具有顯著差異，表示隨著GNRI 分數之上升，病患有較佳之營養狀況，且住院天數有下降的趨勢。故認為針對長期照護機構老人，GNRI 較能作為臨床營養評估工具，以輔助營養師臨床之應用。

The prevalence of malnutrition is very high in elder in Taiwan. This has been demonstrated in every healthcare setting and particularly in long-term care units. The problem of a limited number of dietitians in a long-term care, nutritional screening tools have become vitally important to identify those elders at nutritional risk from the elders in a large facility. We used albumin (Alb), body mass index (BMI), body weight change and Geriatric Nutritional Risk Index (GNRI) to set up an early assessment tool of nutrition status may help in monitoring elder. One hundred twenty- two elders completed this study who were from three long-term care units. GNRI and Alb has significant difference between “normal” and “at risk” groups and negative correlation with length of hospital day(LHS) than other methods. In validity, GNRI better than Alb and BMI can avoid to loss elders who were at risk. To identified the GNRI deeply, there are significant difference with albumin, body weight, hospital day in four levels. It confirmed as GNRI scores increased, could respond to nutrition status. In conclusion, Geriatric nutritional risk index (GNRI) is a good nutritional screen and predictive method in institutionalized resident elderly.

目錄
中文摘要 I
ABSTRACT II
致謝 III
縮寫對照表 V
表目錄 XI
圖目錄 XIII
第一章 前言 1
第二章 文獻回顧 3
第一節 台灣老人問題 3
（一）長期照護及安養照護機構 3
（二）良好照護指標 4
第二節 機構住民之營養議題 5
第三節 營養評估 6
（一）營養評估的重要性 6
（二） 營養評估工具之種類 7
（三）MNA, MNA-SF, GNRI 臨床應用的比較 11
（四）良好營養評估工具之條件 12
第三章 研究動機與目的 14
第四章 受試者與研究方法 15
第一節 受試者招募 15
第二節 收集資料 15
（一）體位測量 15
（二）生化數值分析 16
（三）營養評估 16
（四）追蹤及結果 17
第三節 研究流程圖 18
第四節 統計方法 19
第五章 結果 20
第一節 受試者背景資料 20
第二節 住民營養狀況探討 21
（一）白蛋白及身體質量指數與營養狀況之探討 21
（二）Alb, BMI, GNRI, 體重改變評估與營養狀況之探討 23
第三節 營養評估方法之適用性 29
（一）以GNRI, BMI, Alb 及體重變化單獨篩檢探討病患營養狀況分布 29
（二）以GNRI, BMI, Alb 交叉篩檢探討病患營養狀況分布 29
（三）以GNRI, 三個月體重變化、一個月體重變化交叉篩檢探討病患營養狀況分布 31
第四節 GNRI, ALB, BMI、體重改變與受試者年齡、身體質量指數、白蛋白及住院天數探討（表4） 34
（一）年齡在「正常組」與「營養不良風險組」之探討 34
（二）BMI 在「正常組」與「營養不良風險組」之探討 34
（三）Alb 在「正常組」與「營養不良風險組」之探討 34
（四）一個月住院天數在「正常組」與「營養不良風險組」之探討 34
（五）三個月住院天數在「正常組」與「營養不良風險組」之探討 35
（六）六個月住院天數在「正常組」與「營養不良風險組」之探討 35
（七）白蛋白、身體質量指數及住院天數與營養評估方法之相關性探討（表5） 36
第五節 GNRI, BMI, ALB 分組與個案相關資料的探討： 41
（一）GNRI 分組與個案相關資料的差異性探討 41
（二）BMI 分組與個案相關資料的差異性探討 41
（三）Alb 分組與個案相關資料的差異性探討 42
第六節 預後與GNRI, BMI, ALB三種評估法的關係探討 46
（一）以GNRI 分組後之住院天數及住院風險 46
（二）以BMI 分組後之住院天數及住院風險 48
（三）以Alb 分組後之住院天數及住院風險 48
第七節 GNRI, ALB, BMI 之信度探討 51
第八節 GNRI, ALB, BMI 與ALB, BMI, 因感染住院狀況之效度探討 52
第六章 討論 64
第一節 BMI 與體重下降在長期照護機構的適用性 64
第二節 白蛋白在長期照護機構的適用性 65
第三節 GNRI 在長期照護機構的適用性 66
第七章 結論 68
第八章 研究限制與建議 69
第九章 參考文獻 70
第十章 附錄 78

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