血液透析患者飲食、醫學併發症的認知與飲食配合度之探討
The Association of Knowledge of Diet and the Medical Complication with Dietary Compliance in Hemodialysis Patients
中文摘要
本研究在探討血液透析患者對鈉、鉀、磷、含水量高的飲食認知以及飲食控制不 良所導致的醫學併發症認知與飲食配合度的關聯性。以北部某教學醫院門診血液 透析患者為研究對象，共收集 90 名，其中男性 34 人，女性 56 人，平均年齡 57
±13 歲，身體質量指數平均為 23.5±4.0 公斤/公尺 2，其中 35 人有過重或肥胖問 題，約 6 成有運動習慣，大多無喝酒或抽菸習慣，患者在醫學併發症的認知方面 較飲食認知佳，平均各為 0.89±0.16 及 0.57±0.18 分，但對含鉀或含磷高的飲食認 知較差，平均各為 0.51±0.22 及 0.45±0.26 分。患者的總飲食認知與教育程度、洗 腎的歷史、攝取水果的次數等有關。問卷調查前一個月、當月、後一個月的血鈉、
血鉀、血磷濃度平均為 137.62±3.10meq/L 、4.53±0.63meq/L、5.01±1.31mg/dL，
符合理想值者有 77 人、67 人、63 人（各佔 85.6%、74.4%、70%），透析間體重 增加量平均為 2.59±0.86 公斤，其中小於或等於乾重的 5%有 64 人（71.1%），以 上為飲食配合度佳組；血鈉、血鉀、血磷值大於理想值及透析間體重增加量大於 乾重的 5%者分別有 13 人、23 人、27 人及 26 人（各佔 14.4%、25.6%、30%及
28.9%），為飲食配合度不佳組。兩組在對鈉、鉀、磷、含水量高的飲食認知及醫
學併發症的認知方面均無顯著性的差異，即患者的飲食配合度（血液生化值、透 析間體重增加量）不受其飲食認知好壞的影響。未來宜採用有效衛教方式增強血 液透析患者的飲食配合度，以建立臨床營養師執行營養教育介入的新方向。
英文摘要
The objective of this study was to investigate whether knowledge of diet and the medical complication influences dietary compliance among hemodialysis patients. An interviewer-administered questionnaire assessed patient's knowledge of foods restricted in their diet (i.e. score for knowledge of foods restricted on: sodium, potassium, phosphorus and fluid). Patient's mean monthly serum sodium, potassium, phosphorus and weight charts provided an estimate of dietary compliance.
Ninety patients (♂34, ♀56) with hemodialysis at Chang Gung memorial hospital, Keelung, participated in the study. The average age was 57±13 year-old. Average of body mass index (BMI; kg/m2) was 23.5±4.0, 39% patients was overweight or obesity. About 86% patients did not smoke or drink, and 63% of patients exercised.
The average score of medical complication was better than the score of renal dietary restrictions (0.89±0.16, 0.57±0.18 respectively). The score of total dietary restriction was related with educational level, hemodialysis history, fruit consumption, etc
(p<0.05). The average serum sodium, potassium and phosphorus level were 137.62±3.10meq/L, 4.53±0.63meq/L and 5.01±1.31mg/dL. About 85.6% (n=77), 74.4% (n=67) and 70% (n=63) patients met the above level. According to ideal interdialytic weight gain (less and equal to 5% of dry weight), there were 64 patients (71.1%) matching with that value. All of those patients were classified to compliance group, the other group as noncompliance group. Both groups were no significant difference on the score of renal dietary restrictions and medical complication. The development of new nutritional education intervention might be needed for patients with hemodialysis.
