末期腎病患者選擇透析方式之相關因素探討—以中部某醫學中心為例

Factors Associated with Dialysis Modality Choice for ESRD Patients from a Medical Center in Mid- Taiwan

黃秀蓁(Hsiu-Chen Huang)

指導教授 ： 王俊毅

亞洲大學/健康學院/長期照護研究所/碩士(2008年)

摘要

背景： 2006年總透析費用277億元，腹膜透析醫療成本低於血液透析，然2005年使用腹膜透析與血液透析配比為7.5% v.s. 92.5%（健保局，2007）
目的：探討影響末期腎病患者選擇透析方式的相關因素。
方法：採結構式問卷訪查98位血液透析患者及102位腹膜透析患者。問卷內容包含患者社會人口學變項、對透析方式的認知、家庭及社會資源、自覺心理感受、原發病史和臨床評估等。以Andersen模式為主體，透過統計分析比較使用血液透析與腹膜透析的末期腎病患者其傾向因素、能用因素及需要因素之差異，並建立羅吉斯迴歸模型。
結果：分析結果顯示經年齡和性別調整後，婚姻狀況 (OR=7.54, 95% CI=2.09-27.23)、對透析方式的認知 (OR=1.10, 95% CI=1.02-1.18)、家人或親友支持分數(OR=1.26, 95% CI=1.02-1.54)、單程到院花費時間 (OR=4.13, 95% CI=1.52-11.23)、緊急透析(OR=0.25, 95% CI=0.10- 0.67)、自覺心理感受(OR=1.36, 95% CI=1.23-1.51) 是影響患者選擇透析方式的相關因素。
結論：腹膜透析組對透析方式的認知、家人或親友支持及自覺心理感受分數皆高於血液透析組。建議應建立跨專業醫療團隊合作，早期轉介慢性腎病患者到腎臟科，接受完善的末期腎病前期照護。提升患者對透析方式認知，使患者賦權賦能，得依其喜好與需要選擇適當的透析方式。此外，增加腹膜透析專業人力與機構發展，提供充分資源以客觀地幫助患者選擇透析方式亦是亟待努力的工作。

關鍵字

末期腎病 ； 血液透析 ； 腹膜透析

並列摘要

Objectives: To explore the factors associated with dialysis modality choice for ESRD patients. Methods: 98 Hemodialysis (HD) patients and 102 Peritoneal Dialysis (PD) patients were recruited and interviewed with a structured questionnaire. The questionnaire collects data on social demographic characteristics, cognition of dialysis modality, family and social support, perceived feeling, prior medical history and clinical assessments. Based on Andersen’s medical care utilization model, statistical analyses including chi-squared tests and two-sample t tests, were carried out to compare the predisposing factors, enabling factors, and need factors between the HD group and the PD group. Multiple logistic regression analysis was implemented to explore factors associated with dialysis modality choice. Results: After adjusting for age and sex, factors including marry status (OR=7.54, 95% CI=2.09-27.23), cognition of dialysis modality (OR=1.1, 95% CI=1.02-1.18), family support (OR=1.26, 95% CI=1.02-1.54), traffic time to dialysis center (OR=4.13, 95% CI=1.52-11.23), emergency dialysis (OR=0.25, 95% CI=0.10-0.67) and perceived feeling (OR=1.36, 95% CI=1.23-1.51) are significantly associated with PD use. Conclusion: In summary, we suggest that chronic kidney disease patients should be referred to nephrologists in time to receive complete care and education in the Pre-ESRD stage. To enhance patients’ cognition of dialysis modality and empower patients to make appropriate decisions according to their preference and need is also strongly recommended. Furthermore, sufficient resource of PD, including medical care professionals and facilities, should be provided to help ESRD patients making their choices appropriately.

並列關鍵字

End-Stage Renal Disease ； Hemodialysis ； Peritoneal Dialysis

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