一、 血液透析患者的飲食攝取狀況
長期血液透析的病患容易有蛋白質熱量營養不良的問題發生，除了 血液透析過程流失外，與飲食攝取量、消化吸收障礙和其他疾病因素對 營養素的消耗也有關 (Lim et al., 1993; Malgorzewicz et al., 2010)。對血液 透析患者建議熱量攝取為高於30~35kcal/kg IBW、蛋白質為高於
1.1~1.2g/kg IBW (K/DOQI, 2000)，因為血液透析的過程會增加異化代謝 和氨基酸及胜肽的流失，而許多研究指出：患者平時飲食攝取並無法達 到此建議量，這和尿毒症患者有神經性厭食或味覺異常相關或和透析後 毒素移除產生的不適使食慾下降，導致蛋白質及熱量攝取皆不足夠 (Wright and Weiner, 2012)。
As'habi 的研究中發現伊朗的血液透析病患其飲食攝取的熱量與蛋
將每一組(控制組、15P 組、50P 組）分成白蛋白(Albumin）≦3.8 g/dL 與白蛋白(Albumin）＞3.8 g/dL 兩組分析後如表 4.3 結果顯示，控制組 在白蛋白(Albumin）≦3.8 g/dL 這組，其實驗後測蛋白質攝取量與蛋白 質建議量百分比分別顯著低於前測(p＜0.05），其餘各組則無顯著差異。
計算本實驗之各組補充營養品後，每次約增加 180~380 kcal 不等， 度可增加＜0.25 g/dL，44％患者的血漿白蛋白濃度可增加 0.25-0.49 g/dL，而 27％的患者其血漿白蛋白濃度可增加≧0.5 g/dL (Leon et al.,
血磷偏高，促進副甲狀腺分泌，間接降低血鈣濃度及減少活性維生 鈣化(metastatic calcification）的情形 (Llach and Massry, 1985)。
依美國國家腎臟基金會所提出的建議，透析病人之血鈣和磷乘積數
在氮平衡的研究中顯示，當長期血液透析患者每天攝取蛋白質＜0.8g/kg 組)分成白蛋白(Albumin）≦3.8 g/dL 與白蛋白(Albumin）＞3.8 g/dL，
在補充營養品後，白蛋白(Albumin)＞3.8 g/dL 之 50P 組與白蛋白 (Albumin）≦3.8 g/dL 之控制組之鈉明顯增加；在白蛋白(Albumin）≦
3.8 g/dL 之控制組之鉀明顯增加；白蛋白(Albumin）≦3.8 g/dL 之 50P 組之鈣明顯增加，磷分組後之各組組內則無顯著性差異。然各組之檢驗 數值皆於正常範圍內，無異常值，故在此不予以討論。
在 Caglar 的研究中顯示針對白蛋白＜3.7 g/dL 的血液透析患者補充 普寧勝為期六個月可顯著增加血清白蛋白及前白蛋白 (Caglar et al., 2002)。而另外有研究則是針對白蛋白＜3.5 g/dL 的血液透析患者每天三 次，每次補充口服胺基酸 4 g 為期十二個月，也可顯著增加血清白蛋白 濃度 (Bolasco et al., 2011)。因此，本試驗結果另行依照血清白蛋白濃度
進行分組統計，如圖 4.9 至圖 4.16 所示。白蛋白＞3.8 g/dL 的受試者在
分組後白蛋白(Albumin）＞3.8 g/dL 之 15P 組之組內分析，在補充營養 品後之尿素氮明顯降低。如圖 4.3 與圖 4.11 所示，各組的尿素氮在給予 營養品補充前後之組間分析並未達顯著差異。
肌酐酸在各組之組內與組間分析中，如表 4.4 所示，未分組前之組 內分析，15P 組在補充營養品後明顯降低；如表 4.5 所示，分組後白蛋 白(Albumin）＞3.8 g/dL 之控制組之組內分析，在補充營養品後之肌酐 酸明顯降低。如圖 4.4 與圖 4.12 所示，各組的肌酐酸在給予營養品補
險因素其中之一 (Kalantar-Zadeh and Aronoff, 2009）。在動物實驗中，當 對血色素的影響不大 (Orten and Orten, 1943)。在(Bolasco et al., 2011）的 研究中顯示，當血清白蛋白＜3.5g/dL的血液透析患者再給予胺基酸補充 品4 g (每天三次）三個月後，C-Reactive protein(CRP）顯著降低而血紅 素顯著的增加，並且與給予erythropoiesis-stimulating agent(ESA）劑量之
五、 實驗設計之討論
大品牌，穩定度相對比較高，對使用者而言安全較有保障。(2）此商品 的酪蛋白含量比例較高，故吸收較好，比較適合老人及洗腎患者。在進 行受試者同意書簽署時，血液透析患者原本同意參加本實驗， 然而開 始飲用營養補充品，受試者則決定中途退出，造成收案困難與人數不足 之窘境，因此營養品好喝與否能提高患者參與研究之意願，在實際臨床 應用上的接受度也會比較高，因此改善營養品的適口性是廠商需進一步 加強的地方，由於洗腎患者需嚴格限制水分之攝取，因此市售洗腎配方 均為 2 kcal/mL，本實驗是用粉狀營養品調配，未在口味上多加考慮也是 受試者拒絕參與實驗的原因之一。
本研究由於洗腎室患者人數不多、罹患癌症與年齡大於八十歲者 多，故收案人數有限，加上受試者長時間服用營養品的意願不高，導致 介入時間不長，皆為此研究之限制，期待本研究能引起其他專家學者之 共鳴，未來能做更大型之研究，對於血液透析患者之電解質與營養狀況 做更深入之探討，以提供洗腎患者更好的生活品質。
第六章 結論
本實驗結果顯示長期進行血液透析的患者，於血液透析當天分別給予飲 用含熱量 4 kcal/kg BW 且蛋白質含量分別為 15%及 50％之營養補充品為期四 週，針對白蛋白≦3.8 mg/dL 的透析患者在給予蛋白質含量 50﹪的營養品可顯 著改善其營養狀況，在給予蛋白質含量 15﹪的營養品可顯著改善其血色素，
並且不會影響其電解質平衡。
根據本實驗結果建議：未來在臨床應用上，因疾病或食慾降低導致營養 不良的洗腎患者，可建議短期補充蛋白質含量高之低磷鉀商業配方，而長期 補充鐵含量較高而蛋白質含量 15%之低磷鉀商業配方，則有助於改善營養不 良洗腎患者之血色素情形。
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