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研究生:王沐昕
研究生(外文):WANG,MU-HSIN
論文名稱:腹膜透析病患照顧行為與腹膜炎之病例對照研究
論文名稱(外文):A Case-Control Study on Clinical Behavior and Peritonitis in Peritoneal Dialysis Patients
指導教授:吳麗珍吳麗珍引用關係
指導教授(外文):WU, LEE-JEN
口試委員:周傳姜陳綉琴
口試委員(外文):CHOU, CHUAN-CHIANGCHEN, HSIU-CHIN
口試日期:2017-03-02
學位類別:碩士
校院名稱:長榮大學
系所名稱:護理學系碩士班
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2017
畢業學年度:105
語文別:中文
論文頁數:95
中文關鍵詞:腹膜透析腹膜透析相關行為洗手導管出口感染腹膜炎
外文關鍵詞:peritoneal dialysisbehavior related to PD carehandwashingcatheter exit site infectionperitonitis
相關次數:
  • 被引用被引用:1
  • 點閱點閱:277
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  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
摘 要

在台灣,末期腎臟疾病的發生率和盛行率均居世界第一位,末期腎臟病患者必需以血液透析或腹膜透析保留殘餘腎功能。腹膜透析比血液透析能保留殘餘腎功能,卻可能因為導管出口處感染或換液技術不正確而導致腹膜炎。

本研究採回溯性病例對照研究設計,探討腹膜透析患者居家照顧行為和腹膜炎的關係。研究資料來自南部某醫學中心之電腦資訊病歷匯總系統、疾病分類系統、腹膜透析個管師統計數據及病歷,包括、基本屬性、疾病特性、慢性疾病、檢驗數值、導管出口感染、照顧行為等變項。「病例組」為104年1月至12月期間,在某醫學中心被診斷為一次或兩次以上腹膜炎的腹膜透析病患,共有38人,男性25人,女性13人。同期間無腹膜炎之腹膜透析病患則為「對照組」,有169人,男性106人,女性63人。

分析個別變項和腹膜炎之關係,發現年齡大於60歲、個人無收入、家庭收入3萬元以下、有丙型肝炎、有充血性心臟衰竭、有糖尿病、低白蛋白、及有導管出口處感染與腹膜炎、洗手步驟得分較低、換液過程和換液後處置得分較低的患者有顯著較高的機率患腹膜炎。以邏輯斯迴歸分析檢測所有自變項與是否有腹膜炎有關,就照顧行為來看,腹膜透析病患換液技術分數每增加1分,其罹患腹膜炎風險勝算比會下降16%;總分5分的洗手步驟每增加1分,其罹患腹膜炎風險勝算比會下降19%;總分10分的換液過程和換液後處置分數每增加1分,其罹患腹膜炎風險勝算比會下降50 %;有導管出口處感染者,其罹患腹膜炎風險勝算比會增加4倍。以病患的慢性疾病來看,有丙型肝炎者,其罹患腹膜炎風險勝算比會增加7.7倍;有充血性心臟衰竭者,其罹患腹膜炎風險勝算比會增加6.3倍

本研究顯示腹膜透析病患除了控制慢性疾病,護理人員協助他們確實的洗手步驟、正確的照顧導管出口和換液技術,對於降低腹膜炎非常重要。

Abstract

In Taiwan, the incidence and prevalence rate of end-stage renal disease (ESRD) are the highest in the whole world. ESRD patients need to be treated with hemodialysis (HD) or peritoneal dialysis (PD) in order to retain their residual renal function. PD is a more effective treatment than HD; however, its disadvantages are the risk of infection at the catheter exit site and the potential for peritonitis due to incorrect bag changing and related care.

A retrospective case-control study was used to examine the relationship between behaviors related to PD care and other independent variables and peritonitis. Data were collected from a computerized medical record system, a disease classification system, statistics from PD case managers, and chart reviews in a medical center in southern Taiwan.

Independent variables included the patients’ age, gender, education, income, chronic illnesses, lab data, behaviors related to PD care, and catheter exit site infection. Peritonitis were the dependent variables coded dichotomously as “yes” or “no”. A total of 38 “case” patients, 25 men and 13 women, were either first diagnosed with peritonitis or diagnosed with a recurrent case from January to December 2015. There were 169 “control” patients, 106 men and 63 women, who did not experience peritonitis during the same period.

This study examined the relationship between the individual independent variables and peritonitis. The results showed that those with age greater than 60, no individual income, a monthly family income below 30,000, hepatitis C, congestive heart failure, diabetes, low albumin, a catheter exit site infection, a low handwashing score, and a low bag change and care scores were significantly more likely to have peritonitis. The researcher then used logistic regression to examine the relationship between all independent variables and peritonitis. In terms of PD care related behavior, an increase in handwashing score (0-5) of one point corresponded to a decrease in the odds ratio of peritonitis by 19%, and an increase in the bag change and care score (0-10) of one point corresponded to a decrease in the odds ratio of peritonitis by 50%. Patients with a catheter exit site infection had 4 times the odds ratio of peritonitis compared to patients without a catheter exit site infection. Patients with hepatitis C had 7.8 times the odds ratio of peritonitis compared to those without hepatitis C. Patients with congestive heart failure had 6.3 times the odds ratio of peritonitis compared to patients without congestive heart failure. The other independent variables were not significantly related to peritonitis with logistic regression analysis.

The study results demonstrate the importance of preventing peritonitis by following the exact steps for handwashing before conducting PD and using the correct procedures for bag change and catheter exit site care.

目 錄
第一章 緒論......................................................................................................1
第一節 研究動機與重要性............................................................................................1
第二節 研究目的...................................................................................................6
第二章 文獻查證...................................................................................................7
第一節 腹膜透析的簡介..............................................................................................7
第二節 照顧行為與腹膜透析合併症之關係...............................................................................11
第三節 腹膜炎相關因素.............................................................................................17
第三章 研究方法..................................................................................................25
第一節 研究架構..................................................................................................25
第二節 名詞界定..................................................................................................27
第三節 研究設計..................................................................................................29
第四節 研究對象及場所.............................................................................................30
第五節 資料收集..................................................................................................31
第六節 研究工具..................................................................................................34
第七節 資料處理與分析方法.........................................................................................38
第四章 研究結果..................................................................................................41
第一節 基本屬性、合併慢性疾病、檢驗數值、照顧行為及其他................................................................41
第二節 腹膜透析病患腹膜炎狀況......................................................................................45
第三節 基本屬性、合併慢性疾病、檢驗數值、出口感染與腹膜透析病患腹膜炎之關係................................................45
第四節 照顧行為與腹膜透析病患腹膜炎之關係............................................................................50
第五節 影響腹膜透析病患腹膜炎之相關因素..............................................................................51
第五章 討論.....................................................................................................57
第一節 照顧行為..................................................................................................57
第二節 腹膜炎...................................................................................................58
第三節 影響腹膜炎相關因素.........................................................................................59
第四節 研究限制與建議.............................................................................................68
第五節 結論.....................................................................................................69
參考文獻........................................................................................................73

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