探討臺灣慢性腎疾病患者的臨床參數、運動動機和運動介入成效

The Investigation of Clinical Outcome, Exercise Motivations and Exercise Intervention Effect with Chronic Kidney Disease Patients in Taiwan

林宜靜(Yi-Jing Lin)

指導教授 ： 郭藍遠

高雄醫學大學/醫學院/運動醫學系碩士班/碩士(2016年)

摘要

健保在腎臟相關疾病上的花費十分龐大，慢性腎臟疾病盛行率達10%以上，三高(高血壓、高血脂和高血糖)為其危險因子，且心血管死亡風險是一般人的2~3倍。增加身體活動量可有效控制三高，但腎臟疾病患者的身體活動量較一般人不足，影響其身體活動量的原因分為內在(患者對運動的態度)以及外在因素(醫療人員的支持)，或患者身體客觀上無發從事身體活動，因此本篇實驗目的為調查不同病程的慢性腎臟病患(1)動脈硬化特徵 (2)身體功能特性，並利用問卷了解 (3)患者對於自主從事運動的意願 (4)醫療人員對於患者從事運動的支持。
收取79位慢性腎臟疾病患者，分成三組(1、2期一組；第3期；第4、5期)，利用患者定期抽血檢測分析腎功能和生化指標，利用動脈硬化檢測儀測量了解動脈硬化程度，身體功能包含身體組成、兩分鐘踏步、30秒坐椅子、握力和坐姿體前彎，利用WHOQOL-BREF問卷調查患者生活品質，病患和醫療人員對於運動的態度也以問卷方式調查。
第一組平均年齡50.43歲、第二組64.40歲和第三組60.97歲，動脈硬化指標中，脈波波型分析第二組有較低的平均血壓百分比和上升時間，血壓第三組較其他兩組高，且脈波傳遞速度第一組較其他兩組低。身體組成方面脂肪第二組較第三組高。體適能第二組踏步測試表現優於第三組，第一組握力測試優於坐椅子測試。運動調節問卷在認同調節上第一組低於第三組，醫療人員方面「治療期間從事運動是有好處的」和「慢性腎臟疾病患者認為治療期間需要從事運動」最高分，「大部分慢性腎臟疾病患者在治療期間，從事運動並不費力」最低分。
本實驗提供不同慢性腎臟疾病病程上動脈硬化的特徵，以及在體適能檢測上不同慢性腎臟疾病病程有不同的特性存在，給予運動建議需考量體適能特性差異。
身體功能性與自主意願相關，可能兩者會相互影響。醫療人員對於病患從事運動多持有正向態度，但與病患討論時間偏少。增加運動處方的給予和鼓勵可使運動動機上升。

關鍵字

慢性腎臟疾病 ； 體適能 ； 運動動機

並列摘要

The National Health Insurance used on kidney become a huge burden in the society, even the prevalence of chronic kidney disease was higher than 10%. Its risk factor was hypertension, hyperlipidemia, and hyperglycemia. Cardiovascular mortality was about twice to three times as high in patients with chronic kidney disease that in individuals with normal kidney function. Increasing the physical activity can control the risk factor, but the patient with chronic kidney disease had low physical activity. The influence of patient’s exercise behavior included exercise attitude of patients and medical personnel’s opinions towards recommending exercise to patients during treatment.
Our purpose was to compare arteriosclerosis index, body function between different stages chronic kidney disease. Using questionnaire to investigate exercise motivations and barrier with patients with chronic kidney disease.
Seventy-nine CKD patients was recruited and divided into three groups (Ⅰ: 1,2 stage;Ⅱ:3 stage;Ⅲ:4, 5 stage). Using the regular blood sample exam report to get the biochemical data. The arteriosclerosis index measurements carried out Non-invasive Vascular Screening Device. The fitness assessment include 2 minutes step test, 30 seconds chair stand, grip strength and sit and reach. WHOQOL-BREF was used to assessment patient’s quality of life. Exercise attitude of patients and medical personnel’s opinions towards recommending exercise to patients during treatment were also investigated using questionnaire.
The age with Ⅰ,Ⅱ and Ⅲ was 50.43, 64.40 and 60.97. The percent of mean artery pressure, upstroke time, systolic blood pressure, pulse pressure and pulse wave velocity was significant different between three groups. The fat tissue index was significant correlate with kidney function. The two minutes step test was significant different between three groups. The identified of Behaviral of regulation in exercise questionnaire was significant different between three groups. The medical personnel was strong agree with “In my opinion exercise is beneficial during treatment” and “My patients believe they should exercise during treatment”. “Exercise during treatment for my patients is easy” was most disagree.
Our study provide evidence that difference stage of chronic kidney disease has difference arteriosclerosis characteristic and level fitness. Giving patient exercise suggestion should consider the difference.
The fitness had correlation with patient’s exercise behavior. They maybe affect each other. Although medical personnel support the patients to exercise, the time of discussion with medical personnel about exercise was few. Medical personnel prescribed exercise and supported increasing the exercise motivation.

並列關鍵字

Chronic Kidney Disease ； Fitness ； Exercise Motivations

參考文獻

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