顯影劑造影導致急性腎衰竭之病生理變化個案研討

Pathophysiologic Changes in Contrast Induced Acute Renal Failure: A Case Study

林佳慧(Chia-Huei Lin) ； 王桂芸(Kwua-Yun Wang)

《臺灣腎臟護理學會雜誌》 1卷2期 (2002/12) Pp. 150-159

摘要

隨著醫療技術的進步，儘管對腎臟病的治療有了很大的突破，但在台灣每年仍約有兩三萬腎衰竭病患必須依賴洗腎（黃，1995）。由於現今社會的疾病型態乃以慢性病為主，舉凡糖尿病、高血壓或心臟病等疾病都與腎臟疾病的發展息息相關。腎衰竭分為急性和慢性腎衰竭，而兩者最大的不同在於可逆與不可逆，然而急性腎衰竭病人若未能及時接受適當的治療，將會演變為不可逆性的慢性腎衰竭，必要時將倚賴透析治療或腎臟移植。現今醫療上所使用的顯影劑造影更是誘發病人合併急性腎衰竭的重要因素，尤其對於已有腎功能不全的病人而言，顯影劑更會使患者的腎功能惡化，不僅影響患者全身性的器官，身體的不適更影響生活品質，對病人甚至病人家屬亦是一大負擔。因此，如何降低因急性腎衰竭的病生理變化所導致之生理損傷，是照顧這類病人的重要議題。本文以學理作為基礎，藉一位案例討論，探討其相關病生理變化，提出個別性的評估及護理處置，作為臨床護理同仁在照顧這類病人時之參考，經由學理依據，發揮護理人員之獨立功能，並提升病人之照護品質。

關鍵字

腎功能不全 ； 顯影劑誘發之急性腎衰竭 ； 病生理變化

並列摘要

With improved medical technology available in Taiwan for treating renal disease, there are nearly 30,000 patients with renal failure annually who need dialysis. (Hung, 1995). Chronic diseases, such as diabetes, hypertension, and cardiac disease, all are associated with renal disease. Renal failure can be categorized into two types, acute or chronic renal failure. The major difference between these is reversibility or unreversibility of disease. If patients with acute renal failure (ARF) are unable to get immediate and adequate medical care, they can progress to unreversible chronic renal failure, with a need for further dialysis or even transplantation. The use of contrast dyes for some common medical procedures is a primary cause of drug-induced ARF. Particularly for patients with renal insufficiency, contrast dyes can make patients' renal function worse. This would not only result in damage to major bodily organs, but also could worsen the quality of life and be a terrible burden for patients and their families. Therefore, diminishing the physical damages induced by pathophysiological changes of acute renal failure is an important issue when caring for this kind of patient. In this paper, we use a theoretical basis to discuss one case study of such pathophysiological changes. In addition, we discuss how an individual nursing assessment and related nursing interventions can improve clinical care for these patients and promote a standard for quality nursing care.

並列關鍵字

renal function insufficiency ； contrast-induced acute renal failure ； pathophysiologic changes