飲食熱量與蛋白質攝取改善血液透析患者尾骶骨壓傷個案傷口癒合之個案報告

Dietary Energy and Protein Intake Reduce the Wound Size in a Post-Coccyx Debridement Hemodialysis Patient: A Case Report

10.6709/TJD.202012_12(2).0002

黃鈴君(Ling-Chun Huang)；翁祥育(Hsain-Yu Wong)；楊淑惠(Shwu-Huey Yang)

壓傷 ； 血液透析 ； 營養照護 ； pressure ulcer ； hemodialysis ； nutritional care

臺灣膳食營養學雜誌

12卷2期（2020 / 12 / 01）

17 - 24

繁體中文

壓傷（pressure ulcer）是臥床患者的常見問題，不僅降低了生活質量、增加了死亡率，而且造成了巨額的醫療費用。營養狀況是造成壓傷的危險因素之一。此次個案報告是針對宜蘭某護理之家血液透析患者壓傷個案，進行調整熱量、蛋白質攝取量及協同壓傷護理照顧達到改善個案壓傷狀況之營養照護案例分享。個案64歲女性血液透析患者患有失智，身體質量指數18.0 kg/m^2，為體位過輕。個案意識清楚，坐輪椅，進食時需協助餵食。個案在尾骶骨（coccyx）有10.0 × 7.0× 1.5 cm^3的第四級壓傷，2018年10月24日門診清創手術後回養護機構，2018年11月20日營養師進行營養診斷的個案主要營養問題（problem, P）：經口攝取不足。主因（etiology, E）：護理之家對於食物與營養相關知識不足，因此對於提供符合個案需求之飲食的能力有限。徵候／症狀（signs/symptoms, S）：評估個案熱量和蛋白質攝取低於需求量。營養介入藉由增加飲食熱量、蛋白質密度，改善個案經口攝取不足之情形，以達營養素建議量之需求。個案在專業團隊照護下，傷口逐漸進步縮小。

A pressure ulcer is a common problem for bedridden patients. It affects the quality of life, increases mortality, and medical expenses. Nutritional status is one of the risk factors for pressure injury. In this case report, we aimed to adjust calorie and protein intake and coordinated with wound care to improve the pressure ulcer status. A 64-year-old female hemodialysis patient suffering from dementia, with a body mass index of 18.0 kg/m^2 (underweight). This patient was conscious, walked in a wheelchair, and needed feeding assistance. The case had a 10.0 × 7.0 × 1.5 cm^3 fourth-degree pressure ulcer in the coccyx. On October 24, 2018, the patient was returned to the nursing facility after a debridement operation. A dietitian gave the patient a nutrition diagnosis. Problem: inadequate oral intake. Etiology: about food and nutrition-related knowledge deficit concerning appropriate food intake in the nursing home. Signs/symptoms: an estimate of insufficient intake of energy and high-quality protein from the diet when compared to requirements. Nutrition intervention was to increase dietary energy and protein regimen to meet the nutrient intake recommendation. Under the care of a professional team from November 20, 2018, to February 18, 2019, the wound size and degree were gradually improved.