使用呼吸器的重症病人之維生素B6攝取及營養狀況

研究指出普通住院病人可能有維生素B6缺乏的情形，但對於具有複雜臨床狀況的使用呼吸器的重症病人其維生素B6營養狀況的研究不多。因此本研究的目的是要評估加護病房（intensive care unit, ICU）使用呼吸器之病人其維生素B6的營養狀況，並探討維生素B6對病人疾病嚴重程度 (acute physiology and chronic health evaluation, APACHE II score) 及病情結果的影響。46位 (男性36位;女性10位) 使用呼吸器的重症病人在轉入台中榮總加護病房的第1天和第14天進行生化檢驗、營養素攝取及維生素B6營養狀況的評估。結果顯示病人住院期間維生素B6的平均攝取量，顯著高於目前台灣的建議攝取量（男性老年人，1.6 mg/d；女性老年人，1.4 mg/d），且第14天 (17.5 ± 19.6 mg/d) B6平均攝取量顯著高於第1天 (9.3 ± 16.4 mg/d) 的攝取量 (p < 0.001)，但病人間所攝取的維生素B6的量差異性很大 (0 ~ 87.8 mg)。雖然攝取量增加但病人第14天的血漿PLP (34.6 ± 14.8 nmol/L vs. 42.7 ± 14.5 nmol/L) 及PL (23.2 ± 14.0 nmol/L vs. 28.5 ± 9.5 nmol/L) 濃度卻顯著低於第1天的濃度 ( p < 0.05 )。但EALT-AC及EAST-AC的值並無顯著變化。病人第14天尿液4-PA濃度 (9.4 ± 4.1 mmol/d) 隨著B6攝取量增加而顯著高於第1天 (6.9 ± 5.2 mmol/d) 的濃度。病人APACHE II score、使用呼吸器時間、住ICU及住院天數與病人維生素B6攝取量及其營養狀況指標並無顯著相關性，研究結果得知重症病人因為接受適當且積極的營養支持而有足夠的維生素B6補充，但血漿PLP及PL卻有逐漸降低的情形。

Several studies have reported lower vitamin B6 status in the hospitalized patients. Little is known about the intake and nutritional status of vitamin B6 in the mechanically ventilated critically ill patients who have more complicated clinical conditions. The purpose of this study was to assess vitamin B6 intakes and vitamin B6 status of the mechanically ventilated critically ill patients. In addition, the relationships between vitamin B6 status parameters and the severity of illness (acute physiology and chronic health evaluation, APACHE II) and outcomes (the length of ICU and hospital stay, the length of ventilation dependency) in these patients were also examined. Forty-six mechanically ventilated critically ill patients (36 males, 10 females) in the intensive care unit (ICU) of the Taichung Veteran General Hospital successfully completed this study. Patients’ biochemical measurements, daily nutrient intakes, and vitamin B6 status were assessed at the 1st and 14th d. Results showed that the mean vitamin B6 intake at 1st and 14th d of admission was higher than the current Taiwan Recommended Daily Nutrient Allowance of 1.6 mg/d for elderly men and 1.4 mg/d for elderly women. Patients had significantly higher vitamin B6 ( p < 0.001) intakes at the 14th d (17.5 ± 19.6 mg/d) than the 1st d (9.3 ± 16.4 mg/d) of admission in the ICU. Although many patients had adequate vitamin B6 intakes, individual variation was also considered (0 ~ 87.8 mg). Plasma PLP (34.6 ± 14.8 nmol/L vs. 42.7 ± 14.5nmol/L) and PL concentrations (23.2 ± 14.0 nmol/L vs. 28.5 ± 9.5 nmol/L) significantly decreased while vitamin B6 intakes significantly increased on the 14th d. The mean EALT-AC and EAST-AC values did not significantly change. Unlike the results of plasma PLP and PL concentration, mean urinary 4-PA concentrations was significantly higher at the 14 th d (9.4 ± 4.1 mmol/d) than the 1st d (6.9 ± 5.2 mmol/d). Vitamin B6 intake or status indicators had no effects on the APACHE II score, the length of ventilation dependency, and the length of ICU and hospital stay. Critically ill patients received appropriate and aggressive nutritional support in the ICU, they had sufficient mean vitamin B6 intake and adequate vitamin B6 status. However, plasma PLP and PL concentrations significantly progressively decreased while vitamin B6 intakes significantly increased on day 14.