血液透析病人透析效率相關因素之探討

目的：台灣透析患者發生數從2014年10,668人，增加至2018年12,346人，2018 年以40-64歲發生數最多，65（含）歲以上發生數有逐年增加的情形，透析發生率自2000年每百萬人口331人，新增至2018年每百萬人口523人，大多數的透析患者主要還是以血液透析為主，現今血液透析強調的是透析品質與治療成效，因此本研究目的在於探討血液透析病人透析效率相關因素。方法：本研究採回溯性橫斷面研究設計，運用南部某地區醫院血液透析室資料庫收集資料，收集該院血液透析室2017年10月至2021年9月的個案血液透析基本資料，採用描述性統計、卡方檢定及二元羅吉斯迴歸進行資料分析，找出影響血液透析效率(Kt/V)之預測因子，本研究對象總共148人。結果：女性59人（39.9%）、男性89人（60.1%），平均年齡65.57歲，平均乾體重為62.50公斤；罹患高血壓89人（60.1%），糖尿病66人（44.6%），急性腎衰竭128人（86.5%）、慢性腎衰竭20人（13.5%）；使用自體動靜脈廔管51人(34.5%)、永久性導管30人（20.3%）、PermCath或其他長期導管12人（8.1%）、其他短期導管55人（37.2%），平均血液流速的平均值為每分鐘標248ml，平均血液尿素氮（BUN）沒有異常120人（81.1%）。卡方檢定結果分析性別(χ2=19.267，p<0.001)及腎衰竭(χ2=5.399，p=0.02）達統計上顯著性差異。經由二元羅吉斯回歸結果分析，性別（95%CI:1.198-8.537，p=0.02）、平均乾體重(95%CI:0.866-0.955，p<0.001）、高血壓(95% CI:0.137-0.841，p=0.02）、腎衰竭（95%CI:1.078-48.655，p=0.042）、平均血液流速（95%CI:1.007-1.042，=0.006）與血液透析效率統計上有顯著差異。結論:性別、平均乾體重、高血壓、腎衰竭、平均血液流速與血液透析效率有相關，需注意病人乾體重及及血液流速進行適當的評估來給予病人合適的血液透析劑量，也需針對病人不同潛在疾病問題來進行血液透析效率評估。

關鍵字

血液透析；血液透析效率；血液流速；乾體重

並列摘要

Objective: The number of dialysis patients in Taiwan increased from 10,668 in 2014 to 12,346 in 2018. In 2018, the number of dialysis patients aged 40-64 was the highest, and the number of patients over 65 years old was increasing year by year. 331 people per million population, an increase to 523 people per million population in 2018. Most of the dialysis patients are mainly hemodialysis. Nowadays, hemodialysis emphasizes the quality of dialysis and treatment effect. Therefore, the purpose of this study is to explore blood Factors related to dialysis efficiency in dialysis patients. Methods: This study adopts a retrospective cross-sectional research design, uses the database of a hospital hemodialysis department in the south to collect data, collects the basic data of individual hemodialysis in the hemodialysis department of the hospital from October 2017 to September 2021, and uses descriptive statistics , Chi-square test and binary Logis regression were used to analyze the data to find out the predictive factors affecting the hemodialysis efficiency (Kt/V). There were 148 subjects in this study. Results: 59 women (39.9%) and 89 men (60.1%), with an average age of 65.57 years and an average dry weight of 62.50 kg; 89 people with hypertension (60.1%), 66 people with diabetes (44.6%), and 128 with acute renal failure 20 patients (13.5%) with chronic renal failure;51 patients (34.5%) with autogenous arteriovenous catheters, 30 patients (20.3%) with permanent catheters, 12 patients (8.1% with PermCath or other long-term catheters) ), other short-term catheters in 55 people (37.2%), the average blood flow rate was 248ml per minute, and the average blood urea nitrogen (BUN) was not abnormal in 120 people (81.1%). Chi-square test results showed statistically significant differences in sex (χ2=19.267, P<0.001) and renal failure (χ2=5.399, P=0.02). After binary logistic regression analysis, gender (95%CI: 1.198-8.537, P=0.02), average dry weight (95%CI: 0.866-0.955, P<0.001), hypertension (95%CI: 0.137 -0.841, P=0.02), renal failure (95%CI: 1.078-48.655, P=0.042), average blood flow rate (95%CI: 1.007-1.042, P=0.006) and hemodialysis efficiency were statistically significantly different. Conclusions and suggestions: Gender, average dry weight, high blood pressure, renal failure, and average blood flow rate are related to the efficiency of hemodialysis. It is necessary to pay attention to the patient's dry weight and blood flow rate for proper assessment to give the patient the appropriate hemodialysis dose. It is also necessary to target patients with different potentials. Different hemodialysis efficiency assessments are carried out according to the disease problem.