探討慢性腎臟病人經衛教後的自我照顧與健康行為對腎功能指標之影響

The Exploration of the Influence of Chronic Kidney Disease Patients’ Self - care and Health Behaviors Trained from Health Education on Kidney Function Indicators

游雅珮(Ya-Pei Yu)

指導教授 ： 馬震中

義守大學/醫學院/醫務管理學系/碩士(2014年)

https://doi.org/10.6343/ISU.2014.00285

摘要

研究目的：探討慢性腎臟病人的人口學、病史及自我照顧與健康行為，對於追蹤三年腎功能的影響。
研究方法：採病歷回顧法（Chart review），資料來源以南部某醫學中心腎臟科「末期腎臟病前期（Pre-ESRD）之病人照護與衛教計畫」自2006年起至2010年止，已收案並追蹤滿三年，尚未進入透析而結案的536位病人資料為主。評估變項包括：人口學資料、病史紀錄、自我照顧與健康行為及腎功能指標相關的檢驗報告。
研究結果：在536位慢性腎臟病的病人當中，有60.3% 是男性，52.1%為教育程度在小學（含）以下者，47%第一年的慢性腎臟病分期在第四期，68.8%合併有高血壓、27.1%合併有糖尿病。平均年齡68.33，第一年的eGFR平均在26。自我照顧與健康行為當中的「規則服藥」、「定期回診」和「定時追蹤血液檢查」此三變項得分均接近滿分。「定期自我檢查皮膚」和「規則記錄血壓值」此兩項得分為最低。另外慢性腎臟病人的教育程度、有無伴隨高血脂和神經病變的病人，會顯著影響追蹤三年肌酸酐的數值；而病人的第一年eGFR、第一年慢性腎臟病分期第五期及有糖尿病、規則記錄血壓值，可顯著預測追蹤三年肌酸酐有無倍增的情況。其次，病人的教育程度、第一年的eGFR、第一年慢性腎臟病分期和有無伴隨惡性腫瘤，會影響追蹤三年eGFR的數值；而規則記錄血壓值，可顯著預測追蹤三年eGFR有無下降原本50%的情況。再者，病人的性別、教育程度、第一年的eGFR、第一年慢性腎臟病分期、有無伴隨腦血管病變和惡性腫瘤，會顯著影響第三年慢性腎臟病分期分數。而性別為男性的病人、第一年的eGFR、有伴隨貧血、保持運動和定期自我檢查皮膚，可顯著預測追蹤三年腎功能分期分數。
結論：參加照護衛教計畫的病人，確實會因自我照顧與健康行為的不同，延緩長期腎功能衰退的程度。因此藉由本研究結果，提供醫院管理者及臨床病人照護衛教上的參考。

關鍵字

慢性腎臟病 ； 自我照護 ； 健康行為 ； 肌酸酐

並列摘要

Research Purpose: To explore the influence of demography, medical history, self-care and health behaviors of patients with chronic kidney diseases on renal functions tracked for 3 years.
Research Method: Chart review was adopted with the source of “Care and Health Education Plan for Patients with Pre-End-stage Renal Disease（Pre-ESRD）” provided from the division of Nephrology of a southern medical center. With the period starting from 2006 to 2010, the research has been kept track of for 3 years and completed. The main source of the research was based on 536 patients who hadn’t undergone dialysis. The evaluation variables included: Demographic information, medical history, self-care, health behaviors and inspection reports relating to indicators of renal functions.
Research Result: Among 536 patients with chronic kidney diseases, 60.3% were males, and 52.1% had the education under elementary schools (inclusive), 47% were at the 4th stage of chronic kidney diseases in the first year, 68.8% also had hypertension, and 27.1% also had diabetes. The average age was 68.33, and the average eGFR in the first year was 26. In the influence of self-care and health behaviors, grades of “regular medication”, “regular visits”, and “regular blood test record” were all close to full marks, and grads of “regular self-check skins” and “regular blood pressure record” were the lowest. Moreover, the education and the presence of Hyperlipidemia as well as Neuropathy of patients with chronic kidney disease would significantly influence the value of Creatinine tracked for 3 years; eGFR in the first year, 5th-stage chronic kidney disease in the first year, presence of diabetes and the regular blood pressure record of patients may significantly forecast whether Creatinine tracked for 3 years doubled. Second, the education, eGFR in the first year, the stage of chronic kidney diseases in the first year and the presence of cancer of patients may influence the value of eGFR tracked for 3 years; the regular blood pressure record may significantly forecast whether eGFR tracked for 3 years was reduced by 50% of the original value. In addition, the gender, education, eGFR in the first year, the stage of chronic kidney diseases in the first year and the presence of cerebrovascular diseases and Cancer of patients may significantly influence the grade of the stage of chronic kidney diseases in the third year. Furthermore, the eGFR in the first year, the presence of anemia, regular exercises and the regular self-check skins of male patients may significantly forecast the grades of the stage of renal functions tracked for 3 years.
Conclusion: Patients attending the care and health education plan did postpone the degree of renal failure in a long run due to the different self-care and health behaviors. As a result, the research results may be provided for hospital administrators and clinic patients as the reference to the care and health education.

並列關鍵字

Chronic Kidney Disease ； Self-care ； Health Behavior ； Creatinine ； eGFR

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