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個案報告

個案報告. 營養組 童麗霞. 個案報告. Name : 林 xx ID : G1003XXXXX 性別: 男   年齡 : 67 y/o 入院經過：因覺無力到院治療 PH : HCV(+), CAD, Arrhythmia, DM, HTN AMI s/p stenting. 檢驗報告. Head supratentorial MRI & CT 1) Acute lacunar infarcts in the subcortical region of left occipital lobe

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個案報告

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  1. 個案報告 營養組 童麗霞

  2. 個案報告 • Name:林xxID: G1003XXXXX • 性別: 男   年齡:67 y/o • 入院經過：因覺無力到院治療 • PH: HCV(+), CAD, Arrhythmia, DM, HTN AMI s/p stenting

  3. 檢驗報告 • Head supratentorial MRI & CT 1) Acute lacunar infarcts in the subcortical region of left occipital lobe 2) Old infarct in the left frontal lobe, left PCA territory and bilateral MCA territories. 3) Cortical atrophy 4) Bilateral periventricular leukoariaosis • Lab. data

  4. 藥物

  5. 藥物 vs 血糖(one touch)

  6. 營養評估 S: (by 家屬) 1)飲食習慣:(2個月前) 早餐(7:30):饅頭1個+開水 早點(10:00):蘇打/孔雀絣乾3~4片或土司2片或包子1個 午餐(12:00):飯1碗+燙青菜(醬油)+雞肉/瓜子肉2匙/魚肉3匙 午點(15:00~16:00):同早點 晚餐(17:30~18:00):同午餐 水果:時間不定,1顆柳丁或10顆左右的葡萄/天 水量:自中風後即減少喝水(<1保特瓶/D),也沒有喝牛奶的習慣 其他：偶爾給布丁或果凍(1星期/次)

  7. 營養評估 2)活動度： 自中風後覺得自己變醜了,幾乎不出門 每天約走路15分鐘,傍晚會掃掃地,偶爾作環保義工, 其餘時間多在家裡坐著看電視 3)家中血糖控制狀況: 打濁的胰島素：上午22—24單位,傍晚14單位 沒有做血糖記錄表,印象中早上空腹約為200多 

  8. 營養評估 O/A: 1) 165cm, 61Kg, IBW: 60Kg (normal) 2) Dx: DM, embolic stroke , CAD, HCV(+), HTN, left ACA 3) BEE: 1271Kcal, TER:1525Kcal 4) 一日飲食評估約1450Kcal~1600Kcal/D; 主食過量(13~14ex),蛋白質(≦4ex).油脂(3~4ex)及蔬菜攝食量(<1ex)不足 5) 咀嚼力弱 6) 水分攝取不足/活動量不足 7) 具DM基礎認知,但觀念不完整

  9. 營養評估 P: 1) meal plain 1500Kcal/D 2) 複習DM飲食原則 低血糖處理  軟質均衡飲食原則(優質蛋白質來源/增加纖維質攝食量) 點心攝食原則 3) 鼓勵喝水(1000~1500ml/D)及增加活動量

  10. Postprandial glucose response to Chinese foods in patients with type 2 diabetesJournal of the American Dietetic AssociationVolume: 104, Issue: 12, December, 2004, pp. 1854-1858Chan, Eliza M.Y.; Cheng, Winnie M.W.; Tiu, Sau-Cheung; Wong, Lily L.L.

  11. 受測者基本資料 • 24位Type 2 DM pt, in Queen Elizabeth Hospital, in Hong Kong • 性別: 男性19位; 女性5位 年齡: 55.3±12.5 y/o • BMI: 26.8 ±4.4 • DM 病史: duration of DM 38.9 ±26.3 m.o. (6 ~ 95m.o.) 飲食控制: 7人 ; 低劑量OHA HbA1C: 7.6 ±1.7% • Exclude: GI disease, autonomic dysfunction

  12. 餐食類別 • Meal 1A:plain porridge + lean pork • Meal 1B:plain porridge + shrimp Sho Mai • Meal 2A:boiled rice + boiled egg white • Meal 2B:fried rice + whole egg • Meal 3A:noodles in clear poup • Meal 3B:pickled vegetable + pork-flavored instant bowel noodles

  13. 營養成分分析

  14. 實驗設計 • 1)三組在A1C,年齡,duration of DM及BMI間均無差異 • 2) Avoid alcohol and unusall amounts of exercise for 1 day • before and during the test session

  15. 流程 空腹10小時 fasting hemoglucostick value (all < 15mmol/L) intravenous cannula into forearm vein basal fasting BS give test meal & 250ml H2O (15分內吃完) 30 min intervals for up to 4 hrs after meal (120 min & 240 min after the meal calculated according to the trapezoidal rule)

  16. 統計 • SPSS 11.0 • fasting BS & the AUC of groups 1, 2, 3--- use independent t test • repeat –measures analysis of variance --- analyze the postprandial glycemic profiles of different test meal

  17. Figure: Plasma glucose profile after test meal. (S +瘦肉) (S +燒賣) (飯+蛋白) (炒飯+全蛋) (湯麵) (豬肉泡麵)

  18. 結論 • postprandial glycemic response instant-noodles meal >> plain-noodles meal porridge produced > rice & noodles

  19. ~ THE END ~ 謝謝聆聽

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