管灌飲食對護理之家住民營養狀態影響之回溯性分析

Nutritional Status of Tube-Feeding Institutionalized Residents-A Retrospective Study

10.7023/TJFM.201109.0107

林易申(I-Shen Lin)；王鐘慶(Chung-Ching Wang)；潘玉玲(Yu-Ling Pan)；劉沁瑜(Chin-Yu Liu)；高東煒(Tung-Wei Kao)；羅慶徽(Ching-Hui Loh)；闕宗熙(Tzong-Shi Chiueh)；李美璇(Meei-Sjyuan Lee)；周稚傑(Chih-Chieh Chou)

hypocholesterolemia ； institutionalized ； Mini nutritional assessment short form (MNA-SF) ； tube-feeding

台灣家庭醫學雜誌

21卷3期（2011 / 09 / 01）

107 - 121

繁體中文

目的：探討護理之家住民長期使用管灌飲食與一般經口進食者間，其營養狀態是否差異及其相關影響因子。方法：本研究為病歷回溯性資料分析，由西元2009年1月1日到2009年12月31日間，以居住北部某護理之家住民中，曾接受當年度健康檢查住民之所有病歷資料納入分析。除了收集健康檢查資料中各項生理及生化數據外，還包括住民基本資料、過去慢性疾病史（如：糖尿病、高血壓、高血脂、失智及腦血管疾病等常見慢性疾病）、定期迷你營養評估篩檢量表、以及於體檢後三個月內急診及住院次數；統計方法包括描述性分析、魏可遜二樣本檢定、卡方同質性檢定及邏輯斯迴歸分析。結果：總共收集到78筆住民資料，其中男性佔40位（51.3%），使用管灌飲食者55位（70.5%），經迷你營養評估篩檢量表評估，營養狀況不佳者共有47位（60.3%）。比較管灌組與經口組住民二者，在各項營養指標及三個月內急診及住院次數等記錄上，發現管灌組整體營養表現較差，如：定期迷你營養評估篩檢量表經口組與管灌組，分數分別為11.5±1.4及10.7±1.2 （p=0.012）；小腿圍分別為30.0±4.9 cm，27.7±3.1 cm（p=0.048）；總膽固醇濃度分別為183.5±31.0 mg/dL與161.2±31.2 mg/Dl（p=0.003）；C－反應蛋白濃度分別為0.29±0.27 mg/dL，0.50±0.39 mg/dL (p=0.008)，以及白血球數目分別為6.17±1.34×10^3/μL，7.50±1.85×10^3/μL （p=0.001）。且管灌組在體檢後三個月急診就醫次數顯著高於經口組（0.6±0.9，0.2±0.7，p=0.039）。於卡方同質性檢定中，發現不同進食方式，與性別及過往慢性疾病史間無顯著差異。另外在以迷你營養評估篩檢量表結果為依變項，進行邏輯斯複迴歸分析中，發現營養不良篩檢結果會與小腿圍（OR: 9.473，p=0.001）及低總膽固醇（OR: 4.725，p=0.002）有統計上之顯著關聯性。結論：本研究之結果發現，長期使用管灌飲食之住民相較經口進食者，營養狀態較差，急診就醫次數增加，其原因可能與慢性發炎狀態相關。而早期可評估評估住民營養方法，除選擇迷你營養評估篩檢量表外，藉由簡易量測小腿圍及血中總膽固醇濃度，都將有助於瞭解住民之營養情形。（台灣家醫誌2011; 21: 107-121）

Objective: To investigate the risk factors associated with nutritional status as a result of longterm tube-feeding and orally-feeding of institutionalized residents. Methods: This was a retrospective analysis of the medical records of institutionalized residents from January 1st, 2009 to December 31st, 2009. Residents who had received an annual health examination were included in the analysis. We also collected other information including general demographic data, past medical history (e.g. diabetes, hypertension, hyperlipidemia, dementia and cerebrovascular disease), regular mini-nutritional assessment soft-form (MNA-SF) scores, and the number of emergency visits and hospital admissions within 3 months after the index date. Descriptive analysis, Wilcoxon two-sample tests, Chi-square tests, and logistic regression were performed for statistical analysis. Results: There were 78 institutionalized residents who had annual health examinations during the study period. Forty (51.3%) were male; 55 (70.5%) were tube-feeding; 47 (60.3%) had poor nutrition. The nutritional status of the tube-feeding group was worse than that of the orally-feeding group, as measured by MNA-SF (10.71±1.20 vs. 11.52±1.44, p=0.012), calf circumference (27.7±3.1 cm vs. 30.0±4.9 cm, p=0.048), total cholesterol level (161.2±31.2 mg/dL vs. 183.5±31.00 mg/dL, p=0.003), CRP(0.50±0.39 mg/dL vs. 0.29±0.27 mg/dL, p=0.008), white blood cell count (7.50±1.85×10^3/μL vs. 6.17±1.34×10^3/μL, p=0.001) and number of emergency visits (0.6±0.0 vs. 0.2±0.7, p=0.039). With logistic regression, we also noted that calf circumference (OR: 9.473, p=0.001) and hypocholesterolemia (OR: 4.725, p=0.002) were the main risk factors influenced the scores of the MNA-SF. Conclusions: Poor nutritional status of tube-feeding institutionalized residents may be associated with chronic inflammation. The MNA-SF, calf circumference, and total cholesterol level are useful in early screening of the nutritional status of institutionalized residents. (Taiwan J Fam Med 2011; 21: 107-121)

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