醫療人員資訊系統應用-以血液透析患者健康習慣及生活品質為例

根據衛福部2019年公布107年國人十大死因排行，「腎炎、腎病症候群及腎病變」排名第九，其透析發生率及盛行率高居不下，每年超過九成以上的患者，選擇以血液透析為維持生命之方法。長期血液透析治療對生活品質的衝擊，已是現代醫護相當重視之議題。本研究目的在探討影響血液透析患者健康與生活品質之相關因素，並預測生活品質之重要因素。研究方法採橫斷式研究，以南部某區域醫院之血液透析中心為收案地點。收案以 20 歲以上、意識清醒、熟識國、台語者，並且接受血液透析至少三個月以上為研究對象。研究工具為『參與和自主衝擊問卷』Impact on Participation and Autonomy questionnaire [IPA]）及具疾病特定性質的『腎臟疾病生活品質量表（Kidney Disease Quality of Life [KDQOL]）為評估工具針對本研究的研究問題，採用描述性統計、差異性分析、相關性分析、以及逐步多元線性迴歸分析來進行統計分析。研究結果發現：血液透析患者其健康習慣順為「室內自主性」>「社交關係」>「家庭角色」>「戶外自主性」>「覺察影響程度」>「就業與教育」。室內自主性最佳，就業與教育則為最差的部份。生活品質部份依序為症狀問題部份之生活品質>腎臟疾病的影響>一般心理健康>一般生理健康>腎臟疾病負擔，腎臟疾病負擔為評分最差。以Pearson 積差相關檢視『參與和自主衝擊問卷（IPA）』與『腎臟疾病生活品質量表（KDQOL）』之間的相關性，結果發現兩者間呈低度至中度的正相關。由於 IPA 第一部分和第二部分的相關性高，故分別使用 IPA 第一部分和人口學變項，以及 IPA 第二部分和人口學變項進行逐步迴歸分析。結果發現 IPA 第一部份的「戶外自主性」與第二部份的「覺察影響程度」為預測生活品質最顯著的因子，而人口學變項中的經濟狀態、困難入睡與否、以及夜眠中斷次數、居住縣市別、年齡層等亦是預測血液透析患者之生活品質的因子。結論:健康習慣覺察影響程度和戶外自主性的參與程度是是影響生活品質之重要預測因子，而睡眠相關變項的「夜眠中斷次數」和「困難入睡與否」亦會影響其生活品質。建議醫護人員在面對透析病患出現症狀困擾時，因提早給予適當的護理措施，以提升健康相關之生活品質。

關鍵字

血液透析；生活品質；健康習慣

並列摘要

According to the Ministry of Health and Welfare's 2019 announcement of the top ten causes of death in the country in 107, "nephritis, nephrotic syndrome and kidney disease" ranks ninth, and its incidence and prevalence of dialysis remain high. Ways to sustain life. The impact of long-term hemodialysis treatment on the quality of life has become a topic that modern medical care attaches great importance to. The purpose of this study is to use medical staff information systems to explore related factors that affect the health and quality of life of hemodialysis patients based on quantitative data, and to predict important factors of quality of life. The research method is a cross-sectional study, with the hemodialysis center of a regional hospital in the south as the place of collection. The case study was conducted by people over 20 years of age, conscious, sober, familiar with Chinese and Taiwanese, and had received hemodialysis for at least three months. The research tools are the Impact on Participation and Autonomy questionnaire [IPA] and the disease-specific Kidney Disease Quality of Life [KDQOL] as evaluation tools for this study. To study the problem, use descriptive statistics, difference analysis, correlation analysis, and stepwise multiple linear regression analysis for statistical analysis. The results of the study found that hemodialysis patients' participation in activities followed "indoor autonomy"> "social relations"> "family roles"> "outdoor autonomy"> "perceived impact"> "employment and education". Indoor autonomy is the best, while employment and education are the worst. The quality of life part is the quality of life of the symptom problem part> the effect of kidney disease> general mental health> general physiological health> burden of kidney disease, the burden of kidney disease is the worst score. Using Pearson product correlation to examine the correlation between the "Participation and Autonomous Impact Questionnaire (IPA)" and the "Kidney Disease Quality of Life Scale (KDQOL)", it was found that there was a low to moderate positive correlation between the two. Due to the high correlation between the first part and the second part of IPA, the first part and the demographic variables of the IPA and the second part and the demographic variables of the IPA are used for stepwise regression analysis. The results found that the "outdoor autonomy" of the first part of the IPA and the "degree of perceived influence" of the second part are the most significant factors for predicting the quality of life, and the economic status, difficulty falling asleep, and night in the demographic variables The number of sleep interruptions, the county of residence, age, etc. are also factors that predict the quality of life of hemodialysis patients.