衛教管理介入與血壓、血醣、肌酸酐、總膽固醇與eGFR表現之相關研究

The impact of health education on kidney patients’ blood pressure, FPG, creatinine, total cholesterol, and eGFR: a case control study

林登圳(Deng-Juin Lin)

指導教授 ： 李孟智 ； 白佳原

中山醫學大學/醫學院/醫學研究所/博士(2010年)

https://doi.org/10.6834/CSMU.2010.00032

摘要

背景：台灣平均洗腎人口數排名世界第一，慢性腎臟病為洗腎的高危險族群，然而慢性病的控制可藉由衛教管理方式獲得延緩病情惡化的目的，以衛教管理介入慢性腎臟病之高危險族群減緩腎功能持續惡化的程度尚未被瞭解，因此本研究選擇腎絲球過濾率(GFR)<60ml/min/1.73m2的個案，給予有無衛教管理介入作為研究對象，評估衛教管理介入對血壓、血糖、肌酸酐與GFR間表現相關性。
方法：本研究設計為準試驗研究（quasi-experimental study），共計223名eGFR<60ml/min/1.73m2為研究對象。179人透過衛教管理介入歷經兩年時間，觀察其收縮壓、舒張壓、空腹血糖值、肌酸酐與eGFR的變化，並與對照組44人進行比較分析。
結果：於衛教管理組發現後測收縮壓、舒張壓、空腹血糖值、肌酸酐皆較管理前明顯下降，在總膽固醇與eGFR則呈現顯著上升；在無接受衛教管理組上則只有舒張壓呈現出顯著下降，其他項目則沒有改變。依不同eGFR層級進行衛教管理介入，在eGFR>55ml/min/1.73m2組中，收縮壓、舒張壓、空腹血糖值及eGFR有明顯的改善；在45≤eGFR<55ml/min/1.73m2組中，僅有收縮壓明顯的改善；而在eGFR≤45組中，肌酸酐與eGFR有著明顯的改善。
結論：本研究提供了衛教管理介入慢性腎臟病之高危險族群（eGFR<60ml/min/1.73m2）可能減緩腎功能持續惡化的程度之證據，儘早介入能控制腎功能持續惡化。

關鍵字

慢性腎臟病 ； 衛教管理 ； 腎絲球過濾率(eGFR) ； 血壓 ； 肌酸酐

並列摘要

Background: Taiwan has the highest incidence of dialysis population. Since patients’ education has been demonstrated to be a useful tool to level down the progresses of significant to reduce the deterioration of kidney disease. In this study, researches were performed using those patients whose eGFR is lower than 60/mL/min/1.73m2 to determine the impact of health education on their disease parameters including blood pressure, fasting plasma glucose (FPG),creatinine and eGFR.
Methods: This was a quasi-experimental study. A total of 223 patients, whose eGFR is lower than 60/mL/min/1.73m2, were enrolled into this study. Among them, 179 cases received a 2-year of health education, and neither of the rest of the 44 of selected subjects received any education intervention were served as controls in this research. All these patients’ blood pressure, FPG, creatinine and eGFR were measured and data were analyzed.
Results: The parameters including systolic pressure, diastolic pressure, FPG and creatinine in those patients received education were significantly decreased when compared them with those controls. However, total cholesterol and eGFR were increased significantly. When further characterized the affects of education intervention by different eGFR levels, the results showed that systolic pressure, diastolic pressure, FPG, total cholesterol and eGFR were reduced significantly in patients with an eGFR higher than 55/mL/min/1.73m2, only systolic pressure were improve in patients with an eGFR between 45 to 55/mL/min/1.73m2, and creatinine and eGFR were meliorated in patients with an eGFR lower than 45/mL/min/1.73m2.
Conclusions:The results of this study have provided the crucial evidence that health education intervention on high risk group of chronic kidney patients is able to improve their kidney functions. Furthermore, an early health education intervention shows a positive impact on those chronic kidney disease controls.

並列關鍵字

Chronic Kidney Disease ； Health Education ； eGFR ； Blood Pressure ； FPG

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