血液透析病人的口腔健康狀況與 相關性因素之探討

Associated factors of oral health status in hemodialysis patients

吳淑麗(Shu-Li Wu)

指導教授 ： 黃純德

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士在職專班/碩士(2011年)

https://doi.org/10.6832/KMU.2011.00142

摘要

透析病患為重大傷病，國內文獻血液透析患者牙周狀態屬於中至嚴重程度，同時常伴隨口腔問題，然而口腔健康情形仍是不被注意。由文獻得知透析患者其口腔健康不良情形極為嚴重，同時也被忽略，而國內有關研究也闕乏，故引發研究者動機，希望能探討透析病患口腔健康狀況與疾病間之相關因素，以提供臨床上規劃護理人員在職教育及執行衛生教育指導之參考，進而提升透析病患口腔照護與透析品質。
研究目的：
探討透析病患：1.口腔健康狀況與醫療需求。2.飲食及生活習慣、口腔衛生習慣與看牙醫經驗。3.口腔健康狀況與飲食及生活習慣、口腔衛生習慣、看牙醫的經驗及日常生活活動能力之相關性。
研究方法：
研究設計採橫斷式（cross-sectional study）調查研究法，以台南縣某一區域教學醫院血液透析室病患為對象，利用日常生活活動功能、飲食及潔牙生活習慣之口腔健康狀況及醫療需求調查，及基本資料表，經由牙周病專科醫師實地檢查病患口腔健康狀況，共計96人。以Excel完成資料建檔後，再以SPSS17.0統計軟體進行資料統計分析。
研究結果：
本研究分析結果：男性與女性比例分別為57.3﹪及42.7﹪。年齡分布在28~85歲，平均年齡為64.3歲，其中以≧65歲（50%）比例最高。DMFT指數以65歲以上20.31±11.42為最高，50-64歲14.92±8.05次之，男性17.47±12.53高於女性17.37±10.12，齲齒數為4.91顆、缺牙數為10.48顆，填補數為1.08顆，齲齒率81.25%、缺牙率96.88%、填補率26.06%。教育程度：小學畢業以下佔58.3 ﹪，國初中以上畢業者佔41.7﹪。日常生活活動度（巴氏量表）分級：獨立者51%比例最高。末期腎臟衰竭發病原因以糖尿病引起佔56.3%比例最高，非糖尿病引起為43.7%。接受透析治療月數以少於36各月最多（40.6%），平均治療月數為43.2月。血液透析病患（34.4%）有主動要求吃甜食的習慣，而平均吃甜食的次數，以每月少於6次以下39.58%（N=38人）佔多數，其次為每週>3次以（30.21%）。大部分個案能自己執行刷牙（84.4%），一天刷牙2次（54.2%）。有89人曾看過牙醫經驗（92.7%），就診原因以牙痛（79.8%）佔多數，僅有5.8%定期至牙醫師處做口腔檢查。碎屑指數>1/3以上佔73.96%、牙結石>1/3以上佔46%、牙齦炎中、重度佔88.55%。有36.46%需製作上顎假牙， 32.29%需製作下顎假牙，有21.9%上顎需要補綴復形，而32.29%下顎需要補綴。
結論：
血液透析病人與國內外相關研究比較，口腔情形皆呈現不良狀態，隨著年齡增加而齲齒與牙周狀況變差，以缺牙數明顯增加，但填補率反而減少。影響血液透析病患DMFT指數及缺牙數是重要因素，個案有吃甜食習慣，沒定期做口腔檢查，選擇刷牙方式及合併其他疾病，而使得口腔健康問題更為嚴重。
建議：
一、訂定血液透析病人口腔保健計畫:提高血液透析病人口腔保健服務的醫療給付、慢性腎臟病照護計畫案增加口腔保健服務項目。二、加速相關專業人員培訓：牙醫師人力方面、由專業口腔衛教師積極投入推廣口腔衛生教育、糖尿病與慢性腎臟病衛教師列入培訓種子。
三、持續定期進行口腔檢查與建檔，分析資料以利提出更具體改善計畫。

關鍵字

血液透析 ； 口腔健康狀況 ； 齲齒經驗指數

並列摘要

Abstract

Background
Hemodialysis is a catastrophic illness and major disease; some domestic studies show moderate to severe periodontitis among dialysis patients, often accompanied with oral problems and poor health condition. It has been noted that the status of oral health is easily ignored. There are few studies on dialysis patients and oral health as it’s known that hemodialysis patients with poor oral health situation is extremely serious and needs attention paid to it; therefore, this study aims to investigate the factors influencing oral health status and related disease among hemodialysis patients. The contributions may be significant to nursing staff continuing education and health education to increase the quality of oral health and dialysis among hemodialysis patients.

Purpose
The aim of this study was explore the followings: 1.oral health status and medical needs; 2. eating and living habits, oral hygiene habits and the experience of going to the dentist; 3.the relationships between oral health status, eating and living habits, oral hygiene, the experience of going to the dentist and individual activities of daily living among hemodialysis patients.

Methods
A cross-sectional study design was applied. This study recruited 96 hemodialysis patients in a regional teaching hospital in southern Taiwan. Data collection included individual activities of daily living, diet and living habits and oral hygiene practices, oral health status assessed by periodontitis , medical needs and relevant demographic information. Data was analyzed by SPSS17.0 software package.

Results
The results of the analysis indicated that the DMFT index was 17.43±11.51, and the number of dental caries was 4.91, missing teeth was 10.48, and filled teeth were 1.08. The caries prevalence, missing teeth rate and filling rate were 81.25%, 96.88% and 26.06% respectively. A total of 34% of hemodialysis patients were the average number of eating sweets less than 6 times per month were 39.58% (n =38), 30.21% were less than 3 times per week. Most of the participants were able to brush their own teeth (84.4%), 54.2% of participants brush their teeth twice a day. 89 participants (92.7%) have been to a dentist; dentist visits accounted for 79.8% when toothache occurs. There were 73.96% and 46% of participants had debris index and dental calculus more than one-third of dental surfaces respectively, 88.55% had moderate and severe gingivitis. 36.46% and 32,29% needed upper and lower jaw dentures, 21.9% and 32.29% needed repair for upper and lower jaw denture respectively.

Conclusion
Compared to other studies, it was found that poor oral presentation, dental caries and periodontal condition deterioration increased by age, and the number of missing teeth increased significantly, but the filling rate was found to decrease among d hemodialysis patients. Some factors were found to cause more severe oral health problems among these hemodialysis patients, such as DMFT index, number of missing teeth, habit of eating sweets, lack of regular dental check, brushing method selection and other diseases complications.

Recommendation
1. Establish an oral health care program for hemodialysis patients: increase medical payments in oral health care services among dialysis patients and add oral health care services to the chronic kidney disease program.
2. Accelerate educational training programs in oral health care on relevant clinical professionals: dentists, oral hygiene specialists, diabetes educators and chronic kidney disease educators.
3. Conduct regular oral examination, databank construction and data analysis to facilitate more concrete improvement plans.

並列關鍵字

Hemodialysis ； oral health status ； DMFT index

參考文獻

參考文獻

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