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李彥羲 鹽分攝取減少對高鹽量攝取患者夜尿症之影響 2019/4/30 下午 02:39:23 0
原 文 題  目 Effect of salt intake reduction on nocturia in patients with excessive salt intake
作  者 Tomohiro Matsuo, Yasuyoshi Miyata, Hideki Sakai
出  處 Neurourology and Urodynamics. 2019 Mar;38(3):927-933.
出版日期 March, 2019
評 論

下泌尿道症狀在老人家身上相當常見,除了症狀造成的不適外,也經常影響患者甚至照護者的生活品質。治療各式下泌尿道症狀包含夜尿,經常需倚賴藥物的治療,但需注意,藥物治療本身可能造成的副作用,例如抗乙醯膽鹼藥物可能造成的口乾、便祕等。此外,年長患者常常有慢性病及多重用藥的問題,使得藥物治療選擇更為受限。因此非藥物的治療,例如生活習慣的調整(減重、調整水分攝取、戒菸、減鹽)就佔有一定的腳色。本篇前瞻性研究主要著重在探討鹽分攝取減少對高鹽量攝取患者在下泌尿道症狀及夜尿症之影響。

納入研究對象的條件為男性每天食用超過8克,女性每天食用超過7克的鹽分,並排除罹患泌尿道感染、骨盆腔手術後、骨盆腔器官脫垂、攝護腺肥大、尿道狹窄、神經性膀胱、泌尿道惡性腫瘤、服用可能影響鈉離子藥物之患者。受試者有營養衛教手冊且一個月接受一次臨床醫師及護理專業諮詢,最終的鹽分攝取量是以單次尿液(spot urine)的樣本作推算。

研究結果發現將近七成的受試者(223位)成功減少鹽分攝取,三成(98位)則無法達到。進一步分析,在成功減少鹽分攝取的組別,主觀上夜尿次數平均從2.3次降至1.4次,客觀上在下泌尿道症狀問卷方面不論尿急、日間頻尿、夜尿均達到顯著的改善。而失敗組則沒有此等發現。

根據此篇日本長崎大學研究團隊前瞻性研究的結果,可得到一初步結論,受夜尿症困擾的患者如有高鹽分攝取的飲食習慣,應建議減少鹽分的攝取作為行為療法的重要一環。進階的隨機分配及更大型的研究是未來研究的一個方向。

abstract

Aims: To assess the efficacy of salt reduction for improving nocturia in patients with high salt intake.

Methods: Changes in lower urinary symptoms and frequency volume chart by salt intake (men: 8 g/day; women: ≥7 g/day) were analyzed in this prospective study. Patients were instructed to use a brochure for salt intake restriction via interview once every four weeks. The daily salt intake was estimated by using spot urine samples.

Results: Two-hundred twenty-three (69.5%) patients were successful in reducing their daily salt intake (S group), whereas 98 (30.5%) patients failed to reduce their salt intake (F group). In the S group, nocturia improved from 2.3 ± 0.9 to 1.4 ± 1.0, and nocturnal polyuria index (NPi) improved from 30.2 ± 7.5 to 27.7 ± 7.3% (P < 0.001). In the Core Lower Urinary Tract Symptom Score (CLSS) of the S group, Q3 (urgency) improved from 1.0 ± 1.0 to 0.9 ± 1.0 (P = 0.001); Q1 (diurnal frequency) (P < 0.001), and Q2 (nocturia) also improved (P < 0.001). Moreover, the quality of life parameter improved significantly (P < 0.001). The patients in the F group did not have improvements in any symptom during the study period.

Conclusions: Patients with nocturia who also have high salt intake should be advised to reduce their salt intake, as a lifestyle modification. Our results support the importance of randomized clinical trials with larger populations and the appropriate inclusion/exclusion criteria to conclude the clinical usefulness of salt reduction in this patient cohort.

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