臺灣博碩士論文加值系統

本研究目的為探討剛開始腹膜透析病人接受營養師個別化的飲食指導，並由營養師衛教建議0.8 g/kg/day蛋白飲食加上補充0.1 g/kg/day酮酸胺基酸及單純建議1.0 g/kg/day蛋白飲食12個月後對於營養狀態、腎臟相關指標及殘餘腎功能的影響。本研究為隨機對照試驗，介入組15位剛接受腹膜透析病人，建議0.8 g/kg/day蛋白質飲食並補充0.1 g/kg/day酮酸胺基酸，對照組則為15位剛接受腹膜透析病人，建議1.0 g/kg/day蛋白質飲食，沒有補充酮酸胺基酸，兩組皆有營養師每三個月進行個別化的衛教，追蹤12個月之營養狀態、腎臟功能指標及飲食攝取。結果發現尿量在介入組為-237±401 cc/day，對照組為-535±190 cc/day (P=0.032)，兩組有顯著不同，而尿素氮透析效率 (Kt/V)、白蛋白、氮平衡、正常化尿素氮出現率之蛋白質當量 (nPNA) 在介入組和對照組的改變量皆無差異，均符合美國腎臟基金會 (KDOQI) 所建議的腹膜透析指標。本研究結論為營養師衛教能使腹膜透析病人維持良好的腎功能指標、血磷控制、營養狀態，藉此突顯營養師在腹膜透析病患衛教上的重要性，而補充酮酸胺基酸能維持腹膜透析病人較好的殘餘腎功能。

Purpose: We conducted a randomized trial to test whether a low-protein diet with keto acids would be changing in nutritional status, kidney-related indicators, and associated with a preserved residual renal function (RRF) in initial peritoneal dialysis (PD) patients. Methods: 30 initial PD patients were randomized to receive either a low-protein diet, keto acid-supplemented (sLP: 0.8g/kg/day with 0.1g/kg/day keto acid-supplemented) or a normal protein diet （NP: 1.0 g/kg/day）. The groups were followed for 1 year by dietitians and nutritional status, RRF, kidney-related indicators was evaluated serially. Results: The decrease of urine volume in NP group was more than sLP (NP: -535±190 cc/day vs. sLP: -273±401 cc/day, P = 0.032). There was no significant difference in Kt/V, albumin, nitrogen balance, nPNA between the two groups during follow-up and achieve the KDOQI guidelines recommended.Conclusions: Nutritional education is effective in PD patient maintains a good nutritional status and kidney-related indicators. A diet containing protein 0.8 g/kg/day combined with keto acids is associated with an improved preservation of RRF in relatively new PD patients.

目錄
摘要
Abstract
誌謝
表目錄
圖目錄
壹、前言
一、研究背景
二、研究目的
貳、文獻探討
一、腹膜透析流行病學及現況
二、腹膜透析病人熱量及蛋白質的攝取
三、 酮酸胺基酸對於腎臟病人的益處
四、糖化終產物對腎臟功能的影響
五、營養師的介入對腎臟病人的影響
參、材料與方法
一、 研究對象
二、研究設計
三、飲食衛教
四、資料收集
五、統計分析方法
肆、結果
一、基線之基本資料、理學檢查和臨床生化值之分析
二、腹膜透析病人在接受營養師及酮酸胺基酸12個月介入後腎功能相關數值、營養指標、體位測量、身體組成、營養素攝取的變化
三、介入組和對照組在基線和12個月後的飲食習慣改變
伍、討論
一、營養師衛教對於腹膜透析病人腎功能指標的影響
二、營養師衛教對於腹膜透析病人營養狀態及身體組成的影響
三、營養師衛教對於腹膜透析病人營養素攝取的影響
四、補充酮酸胺基酸對腹膜透析病人殘餘腎功能的影響
陸、研究限制
柒、研究優勢
捌、結論
玖、參考文獻

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