- 學位論文
慢性病洗腎患者流行病之探討—以屏東縣某地區醫院為例
The Epidemiology Study of Chronic Kidney Disease in Pingtung county– Using A District Hospital of Pingtung county as Example
摘要
本研究的目的在於了解屏東縣某一地區醫院96〜98年洗腎病患之篩檢，獲致研究結果如下：屏東縣洗腎病患與其平日飲食、生活習慣、族群(尤其是客家族群、原住民族群)、用藥、高血壓、糖尿病、高膽固醇等疾病皆有息息相關。 研究背景： 由於96年中央健康保險局給付血液透析屏東某地區醫院金額50,684,600元，97年中央健康保險局給付金額53,107,803元，98年中央健康保險局給付金額56,768,244元，中央健康保險給付費用亦逐年增加[4]。 96年洗腎病患男性與女性之比率為38/51，97年洗腎病患男性與女性之比率為48/56，98年洗腎病患男性與女性之比率為48/54；連續3年女性較多。血壓上升是慢性腎臟疾病常見的併發症，雖建議血壓應控制在130/80mmHg以下，然許多病人仍無法達到，即使是使用多種降血壓藥物亦然。慢性腎臟疾病之高血壓可能與腎臟排除鹽分能力受損有關，飲食中蛋白質限制是否與鹽份的攝取量有關聯[21、22、23、24、25]，仍未有定論。 研究方法與材料 研究對象所有年齡層均為研究對象，性別男、女均有；肌酸酐Creatinine高於正常值0.6~1.3mg/dl；血清尿素氮blood urea nitrogen(BUN) 高於正常值：血清6~20mg/dl。問卷調查：用藥服從性、飲食改善、教育程度。Stages of chronic kidney disease Stage I：GFR≥90ml/min/1.73m2 with positive urinary protein；Stage II：GFR 60~89ml/min/1.73m2 with positive urinary protein；Stage III：GFR 30~59ml/min/1.73m2；Stage IV：GFR 15~29ml/min/1.73m2；Stage V：GFR <15ml/min/1.73m2。[12] 研究結果： 洗腎病患在洗腎療程結束後，飲食習慣大幅度改善，由重口味轉為清淡，限制蛋白質飲食，洗腎前合併有高血壓、糖尿病、高膽固醇等症狀之疾病，由表一〜表四，自96年〜98年統計可知洗腎人數逐年增加，新病人、死亡人數亦逐年增加，從問卷調查可得知屏東偏遠地區鄉下居民對慢性腎臟疾病之普通常識，均頗為欠缺，待已發現時均已是第五期(末期)，且合併心血管疾病較多，中央健康保險給付費用亦逐年增加，血液透析病患常見焦慮不安，經常服用兩種以上鎮靜安眠之管制藥品。因此要靠醫護人員至偏遠地區義診時實施衛教，藥師的用藥安全宣導。 96-98年連續3年女性較多，洗腎病患人口數逐年增加，健保給付亦逐年增加，因腎臟末期死亡人數亦逐年增加，洗腎病患對於高血壓的產生與預防，欠缺基本常識，高血壓、糖尿病、高血脂與腎臟疾病是息息相關，因此洗腎病患的衛教、用藥安全是當前最重要的課題。中央健康保險局預算有限，如何降低血液透析病患是當前最重要且是燃眉之急的課題。
並列摘要
The research aims at a sieving analysis of the chronic kidney disease (CKD)patients in a local hospital at Pingtong from 2007 to 2009, concluding the result that as far as the patients in question are concerned, their kidney disease is closely related to such factors as daily diet, lifestyle, ethnic groups (especially hakka and aborigine), medication, hypertension, diabetes, and high cholesterol. Hypertension is a common complication for chronic kidney disease patients. Though they are advised to control their blood pressure under 130/80 mmHg, many patients fail to conform even if they have taken several kinds of anti-hypertension drugs. Hypertension arising from kidney disease may be related to the kidneys failing to release salt; however, there is no final conclusion whether it has anything to do with limited protein or salt intake in patients’ diet. Research subjects: Males and females, aged between 50 and 80, with creatinine level higher than normal 0.6~1.3mg/dl; blood urea nitrogen(BUN) higher than normal serum 6~20mg/dl Questionnaire: Medication compliance, improved diet, and education background. Stages of chronic kidney disease:[1] Stage I--GFR≥90ml/min/1.73m2 with positive urinary protein； Stage II--GFR 60~89 ml/min/1.73m2 with positive urinary protein； Stage III--GFR 30~59ml/min/1.73m2 Stage IV--GFR 15~29ml/min/1.73m2 Stage V--GFR <15ml/min/1.73m2 The kidney disease patients who receive Kidney dialysis have greatly improve their eating habits, taking bland meals with limited protein instead of strong flavored ones. Before receiving kidney dialysis, the kidney disease patents also suffer from hypertension, diabetes, or high cholesterol. As shown in Table 1、Table 2、Table 3、Table 4, the numbers of the patients who received kidney dialysis were increasing from 2007 to 2009, with new patents and death tolls on the increase each year. It can be known from the questionnaire that the residents in the remote countryside of Pingtong are usually poorly informed of chronic kidney disease; as a result, more often than not when the patients are diagnosed to suffer from kidney disease, they are already terminally ill, often alongside with cardiovascular diseases. Besides, National Health Insurance payments are also increasing year by year. Protein restriction and progression of chronic kidney disease：Progression of a variety of chronic kidney diseases (CKD) may be largely due to secondary hemodynamic and metabolic factors, Dietary protein restriction may also be beneficial by exerting nonhemodynamic effects. Multiple well-designed randomized controlled human trials have evaluated both the efficacy and safety of protein restriction in patients with progressive CKD . Moderate protein restriction (0.6 to 0.8 g/kg per day) is associated with a modest but not significant benefit of protein restriction on progression of renal disease. It is generally well tolerated and does not lead to malnutrition in patients with CKD providing caloric goals are met, dietary protein is of high biologic value, and metabolic acidosis is avoided.