血液透析對末期腎病變患者症狀困擾之影響

Influences of Hemodialysis on Symptom Distress in End Stage Renal Disease Patients

吳苡璉(Yi-Lien Wu)

指導教授 ： 林佳靜

臺北醫學大學/護理學院/護理學研究所/碩士(2011年)

https://doi.org/10.6831/TMU.2011.00154

摘要

背景
末期腎病變患者所經歷的症狀困擾是相同於癌症病人，且慢性腎病變患者因疾病所影響的生活品質比癌症病患更大。症狀困擾是主觀的經驗，症狀困擾越嚴重，生活品質滿意度越差，這也顯示出要提昇末期腎病變患者之生活品質，症狀困擾控制是必需要的，症狀要被控制，必須了解病人所表現出來的症狀。使用多方面的評估工具來了解末期腎病變患者的症狀困擾成為非常重要的議題，了解病患的症狀困擾以及評估治療的療效旨於促進病患的生活品質。
研究目的
本研究目的在了解血液透析對末期腎病變患者症狀困擾之影響。
方法
研究設計採橫斷式相關研究方法，以北部兩所教學醫院末期腎病變患者為母取體採方便取樣，共收案211人，分尚未接受透析之末期腎病變患者63人及已接受血液透析之末期腎病變患者148人，分別於門診及血液透析室進行收案，並將收案的211位病患以「八大非癌末期安寧療護疾病-第八項慢性腎衰竭及腎衰竭，未明示者」條例，將末期腎病變患者界定出重症患者，由研究者使用「台灣版安德森症狀量表-腎臟病患專用」進行研究。統計方法以SAS 9.2軟體採相關性研究。
結果
血液透析治療介入可改善末期腎病變患者程度上的症狀困擾，但在末期腎病變重症患者，有血液透析的介入並無法改善病人的症狀困擾。已接受血液透析之末期腎病變患者在規律透析下，血液透析並無法改善病人的症狀嚴重度。
討論
僅管血液透析技術之進步，每年透析病人的死亡率仍達10~15%，多數慢性腎病變患者是在急性機構接受死亡，本研究旨於提高醫護人員對於血液透析病人之症狀困擾關注程度，提供病人更好的症狀管理，更期望研究所得能對國內非癌症病人安寧緩和療護之發展有所貢獻。

關鍵字

末期腎病變患者 ； 症狀困擾 ； 台灣版安德森症狀量表 ； 安寧療護

並列摘要

Background:
End-stage renal disease (ESRD) patients may experience as many symptoms as cancer patients. Symptoms of distress are subjective experiences. It shows that the quality of life in ESRD patient needs to be improved, and symptoms of distress is necessary to be controlled. Symptoms understanding from ESRD patients also become an important part worth study. A multidimensional symptom assessment tool is important to realize the symptom distress. A better understanding of how symptom distress contributes to quality of life will help in tailing and enhancing the efficacy of interventions aimed at improving quality of life.
Aim:
The purpose of this study was to investigate the impact of hemodialysis on symptom distress for end-stage renal disease patients.
Methods:
Cross-sectional surveys of symptom distress scale in subjects with ESRD using a population-based cohort. Patients diagnosed as CKD in nephrology clinic in two teaching hospitals were invited to participate our study after they had signed the informed consent. The sample consisted of 63 ESRD patients without hemodialysis and 148 patients with hemodialysis. They all requested to complete a questionnaire about fatigue scale and International Prostate Symptom Score (IPSS) symptoms scores. The study was also designed to examine the role of hemodialysis in critically ill CKD patients. Study instrument was the M.D.Anderson Symptom Inventory-Taiwan Form kidney disease-specific for a scale in this study. We conducted the analysis using the statistical software SAS 9.2.
Results:
Patients reported that hemodialysis was significantly more likely to improve symptom distress. But in critically ill CKD patients, the intervention of HD did not significantly improve symptoms. In patients under regular maintenance hemodialysis, HD also did not show significant improve symptom distress.
Conclusion:
Despite the improving of dialysis techniques, annual mortality rate in dialysis patients remains 10-15%. The study hopes to make nephrologists and nurses to pay attention to the association between end stage renal disease (ESRD) and symptom inventory. The study raised the question of whether dialysis can improve symptom distress in CKD patients. Understanding the symptom inventory issues of CKD patients would seem to be an important area to explore.

並列關鍵字

end-stage renal disease ； symptom disytress ； MDASI-Taiwan Form ； Palliative care

參考文獻

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