以實證觀點探討傳統主觀透析瘻管理學檢查與客觀儀器檢查的成效

The Efficacy between the Subjective Physical Examination and Objective Mechanical Examination for Dialysis Vascular Access from Evidenced-Base Analysis

吳怡雯(Misoso Yi-Wen Wu) ； 張百純(Bai-Chun Chang) ； 賴秀青(Hsiu-Ching Lai) ； 簡克芬(Ko-Fen Chien) ； 劉雅瑛(Ya-Ying Liu) ； 傅家芸(Chia-Yun Fu)

《高雄護理雜誌》 35卷2期 (2018/08) Pp. 1-9

https://doi.org/10.6692/KJN.201808_35(2).0001

摘要

背景：動靜脈瘻管的監測影響血液透析治療病人的瘻管阻塞發生率。目前的檢查方式有傳統的主觀式理學檢查、客觀式血管攝影(Angiography)與超音波(Doppler Ultrasound)及瘻管流速檢測儀(Transonic FLOW QC)檢查，此四種檢查方式各有其準確性及經濟性方面的考量。目的：應用最佳證據等級實證文獻的評讀，比較主觀理學檢查及客觀儀器檢測透析病人瘻管功能的成效。方法：搜尋Cochrane Library、PubMed Clinical Queries、ClinicalKey、Trip、Uptodate、Dynamed、華藝線上圖書館等資料庫，以PICO(Patient, Intervention,Comparison, Outcome)建立關鍵字。關鍵字為physical examination and dialysis vascular access、angiography、Doppler Ultrasound、Transonic FLOW QC，中文關鍵字以理學檢查及血液透析血管通路進行系統性搜尋，納入2011年之後文獻，依據英國牛津大學實證中心(Oxford Center)臨床研究證據分級。結果：共4篇文獻納入分析，結果發現客觀的儀器檢查與主觀的理學檢查在於瘻管檢測的準確度皆達70%以上。結論：相較於客觀的儀器檢測，傳統理學檢查具有一定的準確度，可用於病人透析前的規律檢查。

關鍵字

透析病人 ； 動靜脈瘻管 ； 理學檢查 ； 儀器檢查

並列摘要

Background：Monitoring of arteriovenous fistulas affects the incidence of obstruction of fistulas in hemodialysis patients. Current methods of examination include traditional subjective physical examinations, objective angiography and Doppler Ultrasound, and Transonic FLOW QC. These four methods are accurate and economical. Aspect considerations.These four methods have their accuracy in evaluation and economic considerations, respectively. Objective：To evaluate the effectiveness of subjective physical examinations and objective instruments in detecting function in dialysis patients by applying the best evidence level of empirical literature. We evaluate the effectiveness of subjective physical examinations and objective instruments in detecting function of dialysis patients by applying the best evidence level of empirical literature. Methods：Search the Cochrane Library, PubMed Clinical Queries, ClinicalKey, Trip, Uptodate, Dynamed, Huayi Online Library and other databases, and create keywords with PICO (Patient, Intervention, Comparison, Outcome). The keywords are physical examination and dialysis vascular access, angiography, Doppler Ultrasound, Transonic FLOW QC, Chinese keywords (理學檢查及血液透析血管通路) for systematic search, included in the literature from 2011 to April 2018, according to Oxford, UK University Research Center (Oxford center) clinical research evidence classification. Results：A total of 4 articles were included in the analysis.There are 4 articles included in the analysis.The results showed that the accuracy of the objective instrument examination and the subjective physical examination of the AVG were more than 50%, and the AVFcould reach more than 70%. The results showed that the accuracies of the objective instrument examination and the subjective physical examination of the AVFcould reach more than 70%. Conclusion：Compared with objective instrument detection, traditional physical examination has certainreliable accuracy and can be used for regular examination before dialysis.

並列關鍵字

dialysis patients ； dialysis vascular access ； physical examination ； Instrument inspection

參考文獻

Ash, S. R., Dhamija, R., Zaroura, M. Y., & Hentschel, D. M. (2012). The StenTec Gauge for measuring static intra‐access pressure ratio (PIa Ratio) of fistulas and grafts. Seminars in Dialysis, 25(4),474-481.

Coentrao, L., & Turmel-Rodrigues, L. (2013). Monitoring dialysis arteriovenous fistulae: It's in our hands. The Journal of Vascular Access, 14(3), 209-215. doi: 10.5301/jva.5000141

Dhamija, R., Nash, S. K., Nguyen, S. V., Slack, K., & Tadeo, J. (2015). Monitoring and surveillance of hemodialysis vascular access using StenTec and physical exam. Seminars in Dialysis, 28(3), 299-304. doi: 10.1111/sdi.12311

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