慢性腎病病人使用暫時性導管啟動長期透析之影響因素

Factors Associated With Starting Dialysis Using a Temporary Catheter Among Patients With Chronic Kidney Disease

賴孟婕(Meng-Jie Lai) ； 周哲毅(Che-Yi Chou) ； 呂淑華(Shu-Hua Lu)

《榮總護理》 35卷3期 (2018/09) Pp. 278-288

https://doi.org/10.6142/VGHN.201809_35(3).0007

摘要

慢性腎病病人非計畫性置入暫時性導管，進行緊急血液透析是增加臨床醫療風險之處置。為瞭解其影響因素，進而能有效衛教無法避免長期透析的慢性腎病病人，計畫性的建置長期通路，以降低醫療風險與耗費。本研究以次級資料分析2006年至2014年間，中部某醫學中心「慢性腎臟疾病共同照護網」中，篩選以長期透析結案的末期腎病前期（Pre-ESRD）病人資料，採回溯性世代研究設計，利用描述性統計、卡方檢定及複邏輯斯迴歸進行統計。結果在464位首次透析病人中，297人（64.0%）使用暫時性導管，發現慢性腎病病人使用暫時性導管啟動長期透析之重要影響因素包括：年紀輕（OR= 0.96, p＜ .001）、腎絲球過濾率低（OR= 0.88, p= .004）、血清白蛋白高（OR= 1.86, p= .017） 與透析前接受衛教（含主動諮詢）次數多（OR= 1.12, p= .023）。本研究結果期提供慢性腎病照護團隊設計預建透析通路相關衛教方案之參考。

關鍵字

慢性腎病 ； 暫時性導管 ； 透析

並列摘要

Admitting patients with chronic kidney disease (CKD) for unplanned double-lumen catheter treatment as a temporary treatment measure for hemodialysis is a risky clinical practice. To gain insight into the factors that control or affect the temporary use of a catheter and to provide further effective health education for patients with CKD that could not avoid use of a catheter, this study employed descriptive statistics, the chi-squared test, and a multivariate logistic regression retrospective cohort design to perform secondary data analysis on 464 patients that underwent dialysis for the first time. The result revealed that 297 (64%) of these patients had used a temporary catheter. Younger age (OR = 0.96, p ＜ .001), lower basal estimated glomerular filtration rate (OR = 0.88, p = .004), higher serum albumin (OR = 1.86, p = .017), and more education sessions (OR = 1.12, p = .023) were identified as influential factors. The results of this study are expected to serve as reference to CKD care teams for the design and establishment of plans and to advance dialysis paths and relevant educational programs.

並列關鍵字

chronic kidney disease ； temporary catheter ； dialysis

參考文獻

陳泰瑜、林麗玫(2017)‧慢性腎臟病病人接受透析的時機‧腎臟與透析，29(3)，132 - 135。doi: 10.6340/KD.2017.29(3).07

許智揚(2008)‧透析病患血管通路的建立及維護‧腎臟與透析，20(2)，63-67。doi: 10.6340/KD.2008(2).01

林燕琴、謝炯昭(2007)‧慢性腎衰竭病人血管通路的手術前評估及術後照護‧腎臟與透析，19(1)，40-44。doi: 10.6340/KD.2007(1).08

邱怡文、黃尚志、陳鴻鈞(2007)‧階段式開始腹膜透析之可行性‧腎臟與透析，19(1)，36-39。doi: 10.6340/KD.2007(1).07

洪燕妮、吳肖琪、吳義勇、柯博仁(2009)‧採用動靜脈瘻管或人工血管之血液透析病人住院醫療利用之分析‧臺灣公共衛生雜誌，28(2)，144-154。doi: 10.6288/TJPH2009-28-02-07