熱量調整對長期使用呼吸器病人之影響

本研究主要的目的是探討調整長期使用呼吸器的病患之熱量，使體重過輕（身體質量指數, body mass index; BMI≦19.9 kg/m2）或過重（BMI＞23 kg/m2）病患達正常身體質量指數（BMI=20-22 kg/m2），對改善其營養狀況及呼吸器脫離之影響。研究對象為台中某地區醫院慢性呼吸照護病房共28位病患。以身體質量指數分為三組，患者使用鼻胃管灌食，對於體重過輕（BMI≦19.9 kg/m2）或過重（BMI＞23 kg/m2）病患，藉以調整每日熱量攝取使其達到正常身體質量指數（BMI=20-22 kg/m2），研究介入為期六個月每個月收集病患客觀性營養評估、主觀性營養評估、營養狀況指標、生化檢驗、呼吸脫離指標。結果顯示介入前後體重過輕組(n =6)的體重並無明顯增加，但體重過重組(n=16)的體重明顯降低(47.9 ± 3.2 vs 49.0 ± 3.1, 65.0 ± 8.8 vs 62.3. ± 8.9 Kg)，三組間白蛋白濃度的變化呈顯著差異。營養評估方法迷你營養評估表、病人主觀整體評估表、老人營養風險指標顯著改善體重過輕組的營養狀況。臨床營養師對於長期使用呼吸器患者準確的熱量供應並配合營養評估，對患者有正面的幫助，預期可減少醫療費用的支出與早日脫離呼吸器。

The main purpose of this study was to explore the effect of adjusting adnormal body mass in dext (BMI) to normal BMI on nutritional status and weaning efficacy in the long-term on ventilator patients. A total of 28 the long-term on ventilator patients from a regional hospital in Taichung chronic respiratory care ward divided by body mass index into three groups; underweight (BMI ≦ 19.9 kg/m2), overweight (BMI> 23 kg/m2) patients and normal body mass index (BMI = 20-22 kg/m2). In order to achieve normal BMI, the daily caloric intakes of patients with nasogastric tube feeding for underweight (BMI ≦ 19.9 kg/m2) or overweight (BMI> 23 kg/m2) patients were modifyied for six months. During the experiment period, atheropomotric nutrition assessment, subjective nutritional assessment, nutritional status indicators, biochemical tests and breathing from the index were monitored for every month. During the experimental period, the underweight group (n=6) did not significantly increase the weight but in the overweight group (n = 16) significantly reduced body weight (47.9 ± 3.2 vs 49.0 ± 3.1, 65.0 ± 8.8 vs 62.3. ± 8.9 Kg, P < 0.05). After six month intervention, blood albumin concentrations, in all three experimental groups were no significant change. Nutritional assessments such as mini nutritional assessment, subjective global assessment, geriatric nutritional risk index were significantly improved in underweight group. There is no significant difference in weaning efficacy among three experiment groups during the six month experiment period. In conclusion, nutrition intervention for long-term ventilator patients with modifying daily calory intake has a benefit in improvement of nutrition status.