Home Visit in Peritoneal Dialysis Patients

腹膜透析病人的居家訪視

張智鴻(Chih-Hung Chang) ； 陳靖博(Jin-Bor Chen) ； 廖上智(Shang-Chih Liao) ； 莊峰榮(Feng-Rong Chuang) ； 許國泰(Kao-Tai Hsu) ； 李建德(Chien-Te Lee) ； 腹膜透析室

《Acta Nephrologica》 20卷3期 (2006/07) Pp. 183-188

摘要

腹膜透析早已是尿毒病人腎臟替代療法的一種選擇，雖然它提供了相當大的方便性，例如減少交通運輸時間，居家治療的便利，但是其所帶來的腹膜感染、導管感染卻是導致中斷腹膜透析的主要原因。藉由家訪可以提供腹膜透析單位人員實地訪查患者居家環境，了解其操作過程和技術正確與否，以及透析液儲存場所是否恰當。這個研究收集了19個患者，分別記錄其家訪中的居家環境、腹膜透析操作技術、患者對腹膜透析的參與度和藥囑遵從性。另外，腹膜炎和導管感染記錄，血液檢查和KT/V，24小時肌酸酐清除率也一併記錄並分析。研究結果發現居家環境和導管感染有顯著的相關性；病患對腹膜透析的參與度和腹膜透析的技術呈現明顯的正相關；年齡，性別，和教育程度對腹膜感染或是導管感染沒有相關性。我們的研究顯示經由居家訪視可以進一步了解腹膜透析病人之腹膜感染、導管感染的可能原因，在這其中，居家環境的清潔又再次的受到強調。另外，只要接受足夠的訓練，各個年齡層或是任何教育程度並不會影響操作技術與參與度，而且與感染的發生無關。

關鍵字

腹膜透析 ； 家訪 ； 腹膜炎 ； 導管感染

並列摘要

Background: Nowadays, peritoneal dialysis has become a popular renal replacement therapy for uremic patients. A home visit program was designed to assess its value and significance in peritoneal dialysis patient care.
Method: From January to April in 1999, 19 uremic patients on peritoneal dialysis received a visit by a professional staff member. The whole visit program included advanced communications on clinical problems, evaluation of technique for peritoneal dialysis, patient participation in dialysis therapy, home environment and drug compliance. A total of 18 items of four major categories were evaluated and assessed by scoring. The association between peritoneal dialysis-related infection and results of home visit was analyzed.
Result: The total home visit score was related to peritoneal dialysis duration (p=0.028). Their participation was significantly associated with dialysis exchange technique (p=0.001). Patients who experienced catheter-related infection have poorer home environment (p=0.031). The age, gender, education level did not affect any infection rate.
Conclusion: Home visit program offers additional information on our care of peritoneal dialysis patients. For those patients with infection complication, home visit is of help to find out factors contributing to their infection.

並列關鍵字

Peritoneal dialysis ； home visit ； peritonitis ； catheter-related infection