心臟手術後卡路里攝取差異對身體活動功能之影響

Abstract

營養不良長久以來對於住院病人一直是個存在的問題。文獻指出，經歷心臟手術的病人中，有10~25%在術前就有營養不良之現象，術後顧及心臟負荷的問題，限制水分攝取往往也影響熱量與營養的攝入，使得體重於術後1.5個月內平均較術前減少5.2 ± 4.3%，在身體的肌力、耐力上也受到干擾。 本研究為觀察性研究，以接受心臟手術之病人為收案對象，於術後收集連續10天的飲食紀錄，並於術前、術後10天、術後30天評估握力、六分鐘行走距離、身體組成(非脂肪組織及脂肪組織重量)之變化，了解卡路里攝取差異對術後身體活動功能及身體組成之影響。收集的資料以Repeated measure ANOVA、Pearson’s correlation、Partial correlation、Independent-Samples T test分析卡路里攝取多寡對握力、六分鐘行走距離、身體組成的變化是否有顯著影響及相關性，檢定之顯著差異水準定為p < 0.05。 依據共66位平均年齡63.3 ± 13.5歲之個案的資料分析結果顯示：(1) 卡路里攝取量，對於握力、六分鐘行走距離、身體組成(非脂肪組織及脂肪組織重量)之表現及變化無顯著相關性，(2) 握力於3個時間點的表現，呈現持續下降之趨勢，由術前的24.6 ± 9.1公斤降至術後30天的22.9 ± 9.1公斤，(3) 六分鐘行走距離於術後10天明顯較術前縮短11.6 ± 96.2公尺，但於術後30天可較術前進步63.8 ± 217.2公尺，(4) 非脂肪組織重量隨3個時間點呈持續減少之趨勢，脂肪組織則無顯著之改變，(5) 水分與卡路里攝取量呈正相關，水分攝取多寡對術後30天六分鐘行走距離表現有顯著之負相關，進一步控制水分變項，卡路里攝取量對於六分鐘行走距離亦無顯著之相關性。

Malnutrition remains a long-existing problem for inpatients. Studies showed that 10-25% of patients who underwent cardiac surgery had malnutrition pre-operatively. Post-operative restriction of water consumption, a way of decreasing cardiac loading post-operatively, affected intake of calories and nutrition, which had negative effects on muscle strength and endurance. Meanwhile, body weight decreased by 5.2 ± 4.3% after cardiac surgery. This prospective and observational study address effects of calories consumption on body activity and compositions in terms of weight of fat free mass and fat mass in patients undergoing cardiac surgery. The daily diets are recorded over a period of 10 days. The grip strength and 6-minute walking distance are checked on pre-operation day, post-operation day 10 and day 30. Data are analysed statistically using repeated measure ANOVA、Pearson’s correlation、partial correlation and independent-samples t-test for evaluation of the effect and relevance of calories consumption on grip strength, 6-minute walking distance and body compositions. A value of p < 0.05 is considered statistically significant.

Sixty-six subjects were included in the study. Mean age was 63.3 ± 13.5 years old. Results are summarized as below: (1) the amount of calories consumption was not significantly related to grip strength, 6-minute walking distance and body composition (weight of fat free mass and fat mass); (2)The grip strength was decreased, from 24.6 ± 9.1 kg pre-operatively to 22.9 ± 9.1 kg on post-operation day 30; (3) The 6-minute walking distance decreased by 11.6 ± 96.2 from pre-operation to post-operation day 10 and increased by 63.8 ± 217.2 between pre-operation to post-operation day 30; (4) The weight of fat free mass had a trend towards reduction over the period shown, whilst there was no significant change in the weight of fat mass; (5) There was positive correlation between water and calories consumption. The intake of water had significant negative correlation in terms of 6-minute walking distance on post-operation day 30. The consumption of calories had no significant relevance to 6-minute walking distance when the variable of water intake was controlled.