末期腎病患者洗腎中之運動訓練及成效—病例報告

Exercise Training during Hemodialysis for a Patient with End-Stage Renal Failure-Case Study

黃文君(Wen-Chun Huang) ； 林恒騰(Heng-Teng Lin) ； 周偉倪(Willy Chou)

《物理治療》 29卷3期 (2004/06) Pp. 196-201

摘要

末期腎病患者因長期洗腎而發生各種併發症，包括各類電解質不平衡、心血管疾病及自主神經病變，進而導致体適能下降；而過去文獻指出，有計劃的運動訓練，可以改善運動耐力、增加心肺功能及改善血脂狀態，對末期腎病患者應有同樣效果。有鑑於目前國內相關文獻不多，加上臨床上執行的個案亦不普遍，故本文選取一位六十歲男性，診斷為慢性腎絲球腎炎，血液透析病史八年之病患作探討；個案執行日常活動即感呼吸急促、行走一百公尺下肢即明顯酸痛，屬紐約心臟功能協會分級第三級；經三個月下肢有氧運動訓練；即選用腳踏車作為訓練工具，並以測試結果之50～80%功率當作強度，每次踩30分鐘，配合每週三次之訓練，並於運動前後各接受一次運動測試，結果顯示病患體適能明顯改善，行走一百公尺下肢無明顯酸痛，且心臟功能分級由第三級進步至第二級。所以我們應鼓勵更多病人從事運動訓練，並能得到更多有關運動訓練好處的結論。

關鍵字

血液透析 ； 運動訓練 ； 心肺功能

並列摘要

During long term of hemodialysis therapy, end-stage renal failure patients suffered from many medical complications such as electrolyte imbalance, cardiovascular diseases, and autonomic dysfunction. These all causes the decline of body fitness. According to previous articles, programmed exercise training can improve patient's endurance, cardiopulmonary function and biochemical lipid profiles. We propose that the end-stage renal failure patients should have the same benefits from exercise training. Few study and clinical case are report on this topic in Taiwan, therefore we selected a 60-year-old gentlemen diagnosed as chronic glomerular nephritis to receive exercise training program. At the beginning of the study, the patient complaint of dyspnea while performing activities of daily life. Soreness over bilateral lower limbs while walking for 100 meters and was diagnosed as functional class Ⅲ by NYHA classification. We placed him on a 30 minutes stationary bicycle training, 3 times a week for 12 weeks with a 50-80% of tested maximal workload as intensity dose. At the end of the study, he was in better fitness situation with less soreness sensation over bilateral lower limbs after walking and improved cardiac function performance up to grade Ⅱ by NYHA. We should encourage all such patient to receive exercise training and then we can make a more definite conclusion about the benefit of exercise training.

並列關鍵字

Hemodialysis ； Exercise training ； Cardiopulmonary function