提升腹膜透析病人血色素符合標準比率之改善專案

本專案主要目的為提升腹膜透析病人血色素符合標準比率。本腹膜透析中心統計2012年3月平均血色素僅為8.7 g/dL，病人血色素達美國食品管理局（FDA）建議標準≧10 g/dL以上，僅約佔49.1％。專案小組為提升腹膜透析病人血色素，分析主要原因為：缺乏腹膜透析病人貧血治療流程和鐵劑建議使用規範、鐵劑使用的遵從性低、慢性出血、血中白蛋白質不足、紅血球生成素的作用認知錯誤、未按時注射紅血球生成素。專案小組提出改善方案如下：（1）定期舉辦透析病人改善貧血團體護理指導（2）制訂鐵劑建議使用規範（3）制訂腹膜透析病人貧血治療和轉介流程。方案執行4個月後，腹膜透析病人平均血色素由8.7 g/dL提升至10.2 g/dL，達標準比率佔65.3％，達到本專案目標值10 g/dL以上，顯示本專案有具體成效。

關鍵字

貧血；鐵質缺乏；治療流程；腹膜透析

並列摘要

This project aims to improve the percentage of peritoneal dialysis (PD) patients with hemoglobin levels that conform to institutional standards. In our PD center, only 49.1% of patients had hemoglobin levels ≧ 10 g/dL and the average hemoglobin levels was only 8.7 g/dL, which lower than the value of 10 ~ 11 g/dL recommended by the U.S. Food and Drug Administration (FDA). We speculated that the main reasons of low hemoglobin level included iron deficiency, low consumption of high-iron content foods due to a lack of knowledge, chronic bleeding without treatment, and inadequate protein intake. This program therefore sought to improve anemia in PD patients through the following measures: (1) holding regular group education sessions; (2) developing a set of recommendations on iron supplements; (3) development of a treatment protocol for anemia. Four months after the program was implemented, the average hemoglobin levels of our PD patients increased from 8.7 g/dL to 10.2 g/dL, and 65.3% of the PD population reached our original target of 10 g/ dL or higher. In conclusion, this anemia-improving project showed positive and encouraging results, and merits further investigation.

並列關鍵字

anemia ； iron-deficiency ； treatment protocol ； peritoneal dialysis

參考文獻

Saunders, S., Mac Leod, M. L., Salyers, V., MacMillan, P. D., & Ogborn, M. R. (2013). Anaemia management protocols in the care of haemodialysis patients: examining patient outcomes. Journal of Clinical Nursing, 1-10. doi: 10.1111/jocn.12059

方昱偉、張宗興（2009）．鐵劑補充療法於腎性貧血的實證觀點．腎臟與透析，21（2），123-125。