探討慢性腎臟病患者衛教介入措施對其自我管理、生活品質及生理數值控制之長期追蹤

Effect of a prevention program on the self-management, quality of life, and disease control of patients with chronic kidney disease

唐敏華(Min-Hua Tang) ； 李文欽(Wen-Chin Lee) ； 丘周萍(Chou-Ping Chiou)

《台灣公共衛生雜誌》 38卷2期 (2019/04) Pp. 203-214

https://doi.org/10.6288/TJPH.201904_38(2).107114

摘要

目標：慢性腎臟病指腎功能逐漸且難以逆轉的衰退，為避免提早進入透析階段，目前醫療團隊提供慢性腎臟病患者疾病控制、飲食治療及日常保健等相關衛教，但病人是否能確實了解衛教內容及落實自我管理，最後得到良好的控制進而提升生活品質，實值得研究探討。方法：本研究採縱貫性研究設計，於南部某醫學中心腎臟科門診進行收案，共收集150位慢性腎臟病患者。以結構性問卷進行資料收集，於收案時、三個月及六個月時進行三次問卷填寫。資料以廣義估計函數式模式（GEE）進行相關資料分析。結果：腎臟病患者之照護與衛教計畫的實施後，隨著時間的增加，病人的自我管理、整體生活品質及eGFR皆有顯著改善情形。另每日規則運動、隨時間增加及eGFR的改善，與生活品質呈正相關。結論：本研究有助於瞭解腎臟病照護與衛教計畫的實施後，腎臟病患者自我管理、生活品質及eGFR的長期變化，建議醫療團隊可介入多元及適才的照護模式，運用衛教計畫的介入及良好的生理控制以提升慢性腎臟病患者之整體生活品質，延緩病人腎功能的惡化，避免提前進入透析階段。

關鍵字

慢性腎臟病 ； 生活品質 ； 自我管理

並列摘要

Objectives: Chronic kidney disease (CKD) is a long-term disease, and to prevent it from developing from the early stage to the dialysis stage, patients follow the advice of their medical team. However, whether patients thoroughly understand the content of the health education that they are provided with and implement self-management to enhance their quality of life is worthy of research and investigation. Methods: This study employed a longitudinal research design and recruited 150 patients with CKD from a medical center in southern Taiwan. Structured questionnaires were used to collect their data a total of three times, and the data were analyzed using GEE. Results: The patients' average score on the short-form Mandarin Health Literacy Scale for CKD was 9.06 ± 3.205, and their self-management, overall quality of life, and eGFR demonstrated significant improvements over time. Conclusions: This study clarified long-term changes in the self-management and quality of life of patients with CKD. Medical teams are advised to provide diverse and proper care models to delay the deterioration of kidney function as well as prevent the need for dialysis in patients with CKD.

並列關鍵字

chronic kidney disease ； quality of life ； self-management

參考文獻

楊宜瑱、盧英立、王威傑、黃建寧：糖尿病生活品質及其相關因素之探討。中華民國糖尿病衛教學會會訊 2014；1 0：2-4。doi:10.6583/TADE.2014.10(1).2. Yang YS, Lu YL, Kornelius E, Huang CN. Quality of life of patients with diabetes and related factors. Newsletter Taiwanese Association Diabetes Educators 2014;10:2-4. doi:10.6583/TADE.2014.10(1).2. [In Chinese]

王淑麗、蕭仕敏、邱怡文、黃尚志、陳鴻鈞：如何執行慢性腎臟病個案管理：南部某醫學中心為例。腎臟與透析 2007；19：6-11。doi:10.6340/KD.2007(1).02. Wang SL, Hsiao SM, Chiu IW, Hwang SJ, Chen HC. Case management of patients with chronic kidney disease -- a case of a medical center in Southern Taiwan. Kidney Dialysis 2007;19:6-11. doi:10.6340/KD.2007(1).02. [In Chinese]

盧瑞芬、曾旭民、蔡益堅：國人生活品質評量（I）：SF-36台灣版的發展及心理計量特質分析。台灣衛誌 2003；22：501-11。doi:10.6288/TJPH2003-22-06-09。 Lu JFR, Tseng HM, Tsai YJ. Assessment of health-related quality of life in Taiwan (I): development and psychometric testing of SF-36 Taiwan version. Taiwan J Public Health 2003;22:501-11. doi:10.6288/TJPH2003-22-06-09. [In Chinese: English abstract]

王淑麗、陳慈徽、龔蘭芳、邱啟潤、林明彥：整體照護計畫對慢性腎臟病病人自我照顧行為與腎功能之影響。長庚護理 2018；29：1-15。 Wang SL, Chen TH, Kung LF, Chiou CJ, Lin MY. The effect of multidisciplinary integrated care program on self-care behavior and renal function in patient with chronic kidney disease. Chang Gung Nurs 2018;29:1-15. doi:10.6386/CGN.201803_29(1).0001. [In Chinese: English abstract]

陳苓怡、郭美娟、黃尚志、蔡哲嘉、陳鴻鈞：臨床評估腎臟功能方法之優缺點。內科學誌 2012；23：34-41。doi:10.6314/JIMT.2012.23(1).05。 Chen LI, Kuo MC, Hwang SJ, Tsai JC, Chen HC. The advantages and drawbacks of methods for assessing kidney function in clinical practice. J Intern Med Taiwan 2012;23:34-41. doi:10.6314/JIMT.2012.23(1).05. [In Chinese: English abstract]