臺灣博碩士論文加值系統

目的 台灣慢性腎臟病成為十大死因之一已達25年之久，政府每年雖積極的推動腎臟保健的防治工作，但每年仍面臨著透析人數上升的趨勢。本研究目的以某醫學中心腎臟科資料進行分析，盼藉由加入國際臨床照護計畫認證(JCI-CCPC)之照護計畫，以JCI國際等級的標準模式結合跨專業以病人為中心的慢性腎臟病整體照護醫療團隊。期望對慢性腎臟病患者獲得較佳的醫療成效，並探討影響因素。
方法 2010年2月起-2011年2月至腎臟科門診就診並由腎臟專科醫師診斷為慢性腎臟病第1-4期患者(18-65歲)，介入組為同意加入JCI-CCPC之照護計畫並追蹤一年共有87位；對照組為僅接受一般治療及無加入任何照護計畫並追蹤一年生理指標共有90位，以t檢定及邏輯斯迴歸統計方法分析兩組之血壓、醣化血色素及膽固醇等生理指標之差異。
結果 本研究結果介入組與對照組在追蹤一年後，其舒張壓及醣化血色素之改變，兩組間有顯著的差異 ( p = 0.042；p =0.007)。膽固醇、三酸甘油脂、尿酸及GFR數值兩組雖有下降，但未達顯著性差異。血壓控制良好與否會受到身體質量指數影響，肥胖相對於健康體位改善程度較小；三酸甘油脂控制良好會受到性別及有無糖尿病共併症影響，女性相對於男性改善程度較大，無糖尿病相對於有糖尿病改善程度較大；醣化血色素改善與否會受到有無糖尿病共併症影響，無糖尿病相對於有糖尿病改善程度較大；尿酸改善與否會受到性別影響，女性相對於男性改善程度較大。
結論與建議 兩組（介入組與對照組）慢性腎臟病患者新收案時及完成一年追蹤評估時，在生理指標前後之變化，其舒張壓及糖化血色素皆達到顯著性差異，介入組在生理指標均且呈現下降改善，表示加入國際臨床照護計畫認證(JCI-CCPC)之介入組較未加入國際臨床照護計畫認證(JCI-CCPC)之對照組確實可以改善患者的生理指標。罹患高血壓或糖尿病是導致慢性腎臟病機率增加最常見的兩大因素，故血壓、糖化血色素能獲得有效的控制改善，將可進一步提昇慢性腎臟病患者的照護成效，因此，建議應多加強及推廣國際臨床照護計畫認證(JCI-CCPC)之照護計畫。

Objective Chronic Kidney disease has become one of ten leading causes of death for twenty five years in Taiwan. Although the government devotes itself to promoting the prevention of kidney health, there are still encountering the trends of increase in the number of dialysis every year. The purpose of this study was to analyze data which was provided by the department of nephrology in one medical center .By incorporating the plan of Joint commission International –Clinical Care Program Certification with the professional medical team which has JCI international level combined with multi-disciplinary and treat the patients of chronic kidney disease as the center, we hope that the kidney-disease patients could have efficient medical treatment. Furthermore, we could utilize the data which provided by the medical center to investigate the factors which could really result in the growing number of kidney disease patients.
Methods Among the patients which was diagnosed as chronic kidney disease stage1-4 (18-65 years old) by nephrologists from February 2010 to 2011 in February, there are 87 patients joining the plan of Joint commission International –Clinical Care Program Certification as the intervention group, on the other hand, 90 patients as the control group who just receive normal treatment. Then, use blood pressure 、Glycated Hemoglobin、and cholesterol measured by the methods of t test and Logistic Regression Analysis to determine the differences between the intervention group and control group.
Results After tracing the intervention group and control group for one year，it is evidently shown that Diastolic blood pressure and Glycated Hemoglobin have obvious differences between these two groups( p = 0.042；p =0.007).However, there are just slightly differences in Cholesterol、Triglyceride、Uric Acid and GFR between them. In addition, blood pressure would be influence by Body Mass Index and obesity could retard the improvement of health. Moreover, gender and diabetes mellitus would play the key role on controlling Triglyceride: Female and without diabetes mellitus patents would make more apparent improvement than male and with diabetes mellitus ones. Furthermore, the main factor which could really influence Glycated Hemoglobin is diabetes mellitus: without diabetes mellitus could make Glycated Hemoglobin well controllable. Last but not least, gender would be the crucial factor for controlling Uric Acid: female would have larger improvement than male.
Conclusions and Suggestions Compare these two groups, intervention group and control group, in two various period, first diagnosed as chronic kidney disease and after tracing one year, there are obvious differences in Diastolic blood pressure and Glycated Hemoglobin. It is evident that blood pressure、Glycated Hemoglobin、and cholesterol would be efficiently controlled in Intervention group. On the contrary, it has no apparent improvement in control group. Therefore, it is said that this outcome is resulted from the plan of Joint commission International
–Clinical Care Program Certification. Moreover, hypertension or diabetes mellitus are the two common factors which could result in chronic kidney disease. Thus, whether blood pressure and Glycated Hemoglobin controlled well or not would play a crucial role in promoting the efficiency of treatment to patients of chronic kidney disease. Thus, it is recommended of me that promotion of the plan of Joint commission International –Clinical Care Program Certification is indispensible for controlling chronic kidney disease.

中文摘要 i
Abstract iii
致謝 vi
目錄 vii
第一章 緒論 1
第一節 台灣慢性腎臟病變環境分析 1
第二節 慢性腎臟病治療與預防 4
第三節 研究目的 6
第二章 文獻探討 8
第一節 慢性腎臟病的定義與相關危險因子 8
第二節 慢性腎臟病防治對腎臟病患者的成效 16
第三節 國際臨床照護計畫認證(JCI-CCPC)介紹 19
第四節 慢性腎臟病照護指標 32
第三章 研究方法 36
第一節 研究架構 36
第二節 資料來源處理與研究對象 37
第三節 研究變項操作型定義 39
第四節 統計方法 42
第四章 研究結果 43
第一節 研究樣本之基本特性 43
第二節 研究樣本之生理指標變化分析 50
第三節 邏輯斯迴歸分析 59
第五章 討論 69
第一節 研究樣本之基本資料現況討論 69
第二節 有無加入國際臨床照護計畫認證(JCI-CCPC)對慢性腎臟病患者生理指標的影響 70
第三節 影響慢性腎臟病患者生理指標相關因子分析 71
第六章 結論與建議 73
第一節 結論 73
第二節 建議 74
第三節 研究限制 76
參考文獻 77

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