血管運動對血液透析病患動靜脈瘻管直徑成效之統合分析

A Meta-Analysis of the Effect of Vascular Exercise on the Diameter of Arteriovenous Fistulas in Hemodialysis Patients

施鳴凰(Ming‐Huang Shih) ； 簡慧足(Hui‐Tsu Chien) ； 游金靖(Chin‐Ching Yu) ； 吳玉鳳(Yuh‐Feng Wu)

《護理暨健康照護研究》 11卷4期 (2015/12) Pp. 308-316

https://doi.org/10.6225/JNHR.11.4.308

摘要

背景：動靜脈瘻管直徑的大小是影響血液透析病患療程順暢與否的主要關鍵，手臂運動、抓握、握球等血管運動方式，是否可促進動靜脈瘻管直徑增大，進而增進瘻管的功能，其效果量缺乏完整性的統合。目的：本研究運用系統性回顧與統合分析法，探討血管運動對血液透析病患動靜脈瘻管直徑之成效。方法：依關鍵字搜尋1996年至2013年發表於The Cochrane Library、EBSCO、ProQuest、政府研究資訊系統（Government Research Bulletin, GRB）、CEPS（Chinese Electronic Periodical Services）中文電子期刊服務及CETD（Chinese Electronic Theses & Dissertations Service）中文碩博士論文資料庫、臺灣博碩士論文加值系統等6種電子資料庫進行文獻搜尋。將符合納入準則之文獻使用Joanna Briggs Institute（JBI）critical appraisal instruments評讀研究品質，並以Comprehensive Meta-Analysis（CMA）統計軟體進行統合分析。結果：共7篇符合評選標準，其中1篇文獻有2筆研究資料，共8筆數據進入統合分析，結果顯示，血管運動增加動靜脈瘻管直徑，其綜合效果量為0.632（95%信賴區間介於0.484-0.779）。結論／實務應用：血管運動可以增加動靜脈瘻管的功能，臨床應用建議每天執行血管運動至少5至6次，每次3秒至5分鐘，且維持至少5至30分，可隨時執行且持續至8週以上，以增加瘻管的直徑進而改善動靜脈瘻管的功能。

關鍵字

血液透析 ； 血管運動 ； 統合分析

並列摘要

Background: The diameter of an arteriovenous fistula is a key variable that is used in hemodialysis. Although vascular exercises such as forearm exercises, handgrip training, and ball squeezing have been claimed to help increase the diameter of arteriovenous fistulas, there is currently no strong evidence to support this claim and the effect size has not been adequately large. Purpose: This article used systematic review and meta‐analysis to explore the effect of vascular exercise on the diameter of arteriovenous fistulas in hemodialysis patients. Methods: We searched for relevant publications in 6 different databases that were published between 1966 and 2013. These databases included: The Cochrane Library, EBSCO, ProQuest, Government Research Bulletin (GRB), Chinese Electronic Periodical Services (CEPS), Chinese Electronic Theses & Dissertations Service (CETD), and Taiwan Periodical Literature System Database. The studies that met the criteria were assessed using standardized critical‐appraisal instruments based on the quality checklist tool of Joanna Briggs Institute. Data from these studies were then analyzed using comprehensive meta‐analysis software in order to synthesize the effect of vascular exercise on the diameter of arteriovenous fistula hemodialysis patients. Results: Seven studies that met the inclusion criteria were included in data analysis. Eight sets of data (two sets of data were used from one article) were available for analysis using comprehensive meta‐analysis software to synthesize the effect of vascular exercise upon the diameters of the arteriovenous fistulas in hemodialysis patients. The results demonstrated that vascular exercise improved vascular diameter, thus achieving a moderately positive effect (standard mean difference 0.632, 95% CI [0.484, 0.779]). Conclusions/ Implications for Practice: Vascular exercise is effective in improving arteriovenous fistula functions. For clinical practice in the future, we recommend that patients perform vascular exercise for 3 seconds to 5 minutes per time for a sustained period of at least 5-30 minutes and for at least 5-6 cycles daily for more than 8 weeks in order to improve the diameter and thus enhance arteriovenous fistula functions.

並列關鍵字

hemodialysis ； vascular exercise ； meta‐analysis

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