臺灣博碩士論文加值系統

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。

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.

中文摘要 I
Abstract III
目錄 V
附錄 VII
第一章 緒論 1
第一節 研究背景與研究動機 1
第二節 研究的重要性 7
第三節 研究目的 9
第二章 文獻探討 10
第三章 研究方法 18
第一節 Part1 衛教管理介入與血壓、血醣、肌酸酐、總膽固醇與eGFR表現 18
一、研究設計 18
二、 研究對象 18
三、研究工具 20
四、資料分析方法 21
第二節 Part2「腎臟疾病個案管理計畫」管理之分析 22
一、研究流程 22
二、研究對象 23
三、研究工具 24
四、資料分析方法 26
第三節 名詞界定 29
第四章 研究結果 30
第一節 Part1衛教管理介入與血壓、血醣、肌酸酐、總膽固醇與eGFR表現 30
一、樣本特質描述分析 30
二、管理組與無管理組之各項生化參數前後測結果資料分析 31
三、管理組與無管理組間之前後測變化量資料比較 32
四、eGFR分層於管理前後各項參數值之表現情形 33
五、管理組以多變項迴歸模式評估研究對象之肌酸酐及eGFR變化量的影響因子 34
第二節 Part2 「腎臟疾病個案管理計畫」管理之分析 35
一、腎臟病篩檢之醫療服務品質及滿意度調查 35
二、基本特性 36
三、腎臟功能篩檢項目追蹤分析 37
四、異常個案各項健康行為調查問卷追蹤分析 39
五、個案管理紀錄卡追蹤分析 41
六、結構方程模式分析 44
第五章 討論 46
第一節 主要發現 46
第二節 綜合討論 48
第三節 研究限制與建議 53
參考文獻 56

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