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研究生:呂聰明
研究生(外文):Leu, Tsong-Ming
論文名稱:接受血液透析治療之尿毒患者的腕道症之研究
論文名稱(外文):A Study on Carpal Tunnel Syndrome in Uremia Patients Receiving Hemodialysis
指導教授:林中生, 張楊全
指導教授(外文):Chung-Sheng Lin, Yang-Chyuan Chang
學位類別:碩士
校院名稱:中山醫學院
系所名稱:醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
畢業學年度:84
語文別:中文
論文頁數:70
中文關鍵詞:腕隧道症多發性神經病變尿毒症血液透析糖尿病電氣學診斷
外文關鍵詞:carpal tunnel syndromepolyneuropathyuremiahemodialysisdiabeteselectrodiagnosis
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以中山醫學院附設醫院接受血液透析的尿毒患者共 62 人,男性 32 人,
女性 30 人,平均年齡 58.4 歲,平均接受血液透析治療時間為 4.37 年
,以問卷、臨床檢查、抽血及電氣診斷檢查等,來評估洗腎患者的腕隧道
症或多發性神經病變之發生率,洗腎時間或β -2 微小球蛋白
(microglobulin) 與腕隧道症之關係,洗腎病人做動靜脈分流對腕隧道症
發生的影響。在本研究中,並且以正常者 45 人,男性 22 人,女性 23
人,平均年齡 50.7 歲,為控制組。結果顯示腕隧道症之發生率為 56 手
/ 124 手 ( = 45.2 % ) 比一般報告偏高,多發性神經病變之發生率
為 35 人/62 人 ( = 56.5 % ) 。以 Polymethylmethacrylate 為透
析膜洗腎者,較使用 cuprophan membrane 者,有較低的腕隧道症發生率
。 血液中β -2 microglobulin 濃度或洗腎時間,與腕隧道症之發生,
皆無相關性。動靜脈分流至腕關節距離與腕隧道症發生率,也無相關性。
以電氣診斷檢查,發現洗腎患者神經傳導速度比控制組慢,而神經傳導潛
時則較控制組延長,但洗腎患者的做血管分流與未做血管分流的手,則沒
有差別。糖尿病患和非糖尿病的尿毒患者,與控制組比較神經傳導速度、
神經傳導潛時及神經傳導振幅,發現非糖尿病的尿毒患者比控制組差,糖
尿病患又比非糖尿病的尿毒患者更差,但是糖尿病患與非糖尿病的尿毒患
者,其做或未做血管分流,與臨床症狀之有無並無相關性,但與腕隧道症
之發生有相關性,因此血液透析的尿毒患者做動靜脈分流並不會影響到神
經傳導速度、神經傳導潛時及神經傳導振幅,糖尿病與尿毒病患皆可造成
多發性神經病變,而在尿毒患者中,糖尿病患比非糖尿病患有較高的腕隧
道症發生率,且電氣診斷檢查為最理想且最敏感的腕隧道症診斷方法。

A study to investigate the relationships between
hemodialysis and carpaltunnel syndrome (CTS) or polyneuropathy
was performed on 62 uremic patientsin Chung Shan Medical and
Dental College Hospital. There were 32 males and 30 females,
with a mean age of 58.4 years and a mean hemodialysis period of
4.37years. All the patients received questionnaire interview,
medical review,physical check-up, and neurological examinations.
The site of artificial arteriovenous (AV) shunt in the forearm
was carefully recorded. The blood levelof β2 microglobulin was
determined. Motor and sensory nerve conduction studieson the
bilateral median and ulnar nerves were carried out.
For an electrodiagnostic comparison, 22 male and 23 female
normal subjects were enrolled as a control group. The prevalence
of CTS in the uremic patients was 45.2 %(56 hands /124 hands)
which was higher than those reported in the literature.The
occurrence rate of CTS was lower in the uremic patients
receiving hemodialysis with polymethylmethacrylate than those
with cuprophanmembrane hemodialysis. Both the blood β2
microglobulin level and dialysisperiod were not
influentialfactors on the occrrence rate of CTS, neither didthe
distance between AV shunt and wrist joint. The prevalence of
polyneuropathywas 56.5 % which was lower than those reported
in the literature. In nerveconduction studies, uremic
patients had slower nerve conduction velocities,(NCVs), longer
latencies and lower amplitudes of evoked action
potentialsthan the normal subjects. Between the shunting and
non-shunting hands, therewere nosignificant differences of NCVs,
latencies, or amplitudes of actionpotentials. All of these
electrodiagnostic parameters were more severelyaffected in the
diabetic than the non-diabetic uremic patients.
Theseelectrodiagnostic differences had a good accordance with
the clinicalfindings of higher incidence of CTS or
polyneuropathy in the diabetic thanin the non-diabetic
patients. In conclusion, uremic patients with hemodialysishad a
high incidence of CTS. The contributing factors were dialysis
materials,and coexisted diabetes. Nerve conduction studies
provide a sensitive method toevaluate CTS in theuremic patients.

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