心衰竭住院患者鈉攝取量與體液滯留嚴重度的相關性

Abstract

背景：心衰竭是一個致死率高的症候群。患者常因體液容積過量症狀而再住院。有研究以鈉攝取量為介入措施，探討低鈉飲食對心衰竭體液滯留的效果，但少有文獻報告患者的鈉攝取量。目前也尚未蒐集到國內患者的這方面資料。 目的：本研究擬探討心衰竭住院患者鈉攝取量、體液滯留嚴重度；鈉攝取量和體液滯留嚴重度的相關性；患者分別在不同飲食來源、不同病情嚴重度下，鈉攝取量的差異性。 設計：本研究採非實驗性研究設計。 方法：本研究在北部某醫學中心，以便利取樣方式選取患者。收案條件為意識清；能以國、台語溝通；最近一星期內血清肌酐酸值：男性患者 ≦ 2.54 mg/dL，女性患者 ≦ 2.06 mg/dL。排除條件為醫師診斷有失智症、肝臟疾病、週邊血管疾病、呼吸道疾病、發燒、腹瀉；無法配合收集小便；目前正接受以下治療：呼吸器、需定期洗腎、輸血、靜脈滴注食鹽水或禁食。最後共邀請116位患者參加研究，其中有5位在參加研究期間出院，11位拒絕邀請，故最後100位患者進入資料分析。主要研究工具為體液滯留嚴重度量表和生化分析儀。以SPSS 17.0進行統計分析。描述性資料採全距、平均值、標準差、百分比分析；推論性資料採Pearson correlation, Spearman rho, t-test和單因子變異分析。 結果：患者平均年齡為73 ± 14歲，以男性(63%)、教育程度在小學或以下(66%)、有偶(86%)、NYHA 功能等級Ⅲ(36%)居多。資料顯示：1. 患者平均鈉攝取量2.97 ± 2.56克/天。2. 不同病情嚴重度患者的鈉攝取量，無顯著差異(p = .31)。3. 患者的體液滯留嚴重度，得分範圍0~18分，平均得分為6.62 ± 4.97分(滿分28分)。4. 不同病情嚴重程度患者的體液滯留嚴重程度，有顯著差異(p = .00)。5. 鈉攝取量與體液滯留嚴重度，無顯著相關(p = .70)。6. 不同飲食來源的鈉攝取量，無顯著差異(p = .54)。7. 患者的鈉攝取量超過護理指導的建議(p = .03)。 結論與建議：本研究結果顯示住院患者平均鈉攝取量為2.97克/天。雖然鈉攝取量與體液滯留嚴重度沒有顯著相關，但患者平均鈉攝取量，仍高於護理指導的建議。表示鈉攝取量在心衰竭照護，仍是值得重視的議題。本研究結果同時發展出體液滯留嚴重度量表，不僅驗證其信效度，同時顯示其量測值與病情嚴重度有顯著相關。此量表為特定性量表，運用於測量心衰竭的體液滯留症狀，方便未來運用於臨床護理心衰竭患者之自我監測體液滯留情形，或研究類似議題上的工具選擇。

Background: Heart failure is a syndrome with high mortality. Patients’ re-hospitalizations were often due to fluid overload symptoms. Although there were some research using dietary sodium as an intervention to export low dietary sodium effect on fluid overload in heart failure, few reports about amount of daily dietary sodium in patients with heart failure. In Taiwan, data of amount of daily dietary sodium in patients with heart failure were not yet collected. Aims: Inpatients with heart failure were invited to participate in this study. The purposes of this study were 1) to investigate dietary sodium intake and severity of fluid overload symptoms, 2) to explore the relationship between dietary sodium intake and severity of fluid overload symptoms, 3) to compare amount of dietary sodium intake and severity of fluid overload symptom under variance of dietary source and disease severity. Designs: This study design was a non-experimental research. Methods: Patients were recruited using convenience sampling from a medical center in northern Taiwan. The inclusion criteria were as follows: alert and had clear thinking, with ability to speak Chinese or Taiwanese, serum creatinine ≦ 2.54 mg/dL (male) or ≦2.06 mg/dL (female) in the latest week. The exclusion criteria were as follows: dementia, hepatic disease, renal disease, peripheral vascular disease, or respiratory disease, fever and diarrhea based on medical record; not available for urine collection, under ventilator, hemodialysis, blood transfusion, intravenous saline infusion and fasting treatment. A total of 116 patients were invited to join this study. Five out of 116 patients discharged during study. Eleven out of 116 rejected the study. Finally, a total of 100 patients entered the study. Fluid Overload Symptoms Scale and biochemical analyzes (Hitachi 7600 series automation system clinical analyzer) were major instruments for data collection. All analyses were conducted with SPSS version 17. The descriptive statistics used in the study includes range, mean ± standard deviation, frequency and percentage. The inferential statistics includes Pearson correlation, Spearman rho, t-test, and one-way ANOVA. Result: It was found that the patients had a mean age of 73 ± 14 years; 63% were males; 66% had an education level the equivalent of or less than junior high school; 86% were married; 36% were New York Heart Association functional classⅢ. This result showed that: 1) mean dietary sodium intakes was 2.97 ± .57 gm/day; 2) different disease severity was not significant in the amount of daily dietary sodium intake (p = .31); 3) mean fluid overload symptom score was 6.62 ± 4.97 points (range: 0~18 points); 4) levels of disease severity were significant in fluid overload symptom score (p = .00); 5) there was no significant correlation between the amount of daily dietary sodium intake and the severity level of fluid overload (p = .70); 6) different dietary source was not significant in the amount of daily dietary sodium intake (p = .54); 7) heart failure patients’ dietary sodium intake amount was more than what was recommended from nursing instructions. Conclusions and Suggestions: The result of the study shows that patients’ average dietary sodium intake was 2.97 gm/day, and that sodium intake and severity of fluid overload was not significantly correlated. In addition, the results of this study also show that average patients’ sodium intake is higher than that recommended in nursing instructions; hence, the amount of dietary sodium intake is still an important issue in heart failure care. In this study, a Fluid Overload Symptom Scale was developed and exhibited reliability with construct and criterion validity in the measurement of severity of fluid overload symptoms, exhibiting the validity of the scale. Being a specific measurement tool for fluid overload symptoms in heart failure, the scale is certainly convenient for patients to use in self-monitoring.