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研究生:簡玉惠
研究生(外文):Yu-Hui Chien
論文名稱:探討末期腎臟病人的透析治療與衰弱症之相關性
論文名稱(外文):The association between Dialysis and Frailty among Patients with end-stage renal disease
指導教授:藍祚運藍祚運引用關係陳世豐
指導教授(外文):Tzuo-Yun LanShih-Feng Chen
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:醫務管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2019
畢業學年度:108
語文別:中文
論文頁數:107
中文關鍵詞:慢性腎臟病第五期透析治療衰弱症
外文關鍵詞:chronickidney disease stage 5dialysis therapyfrailty
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背景:根據美國腎臟資料系統2015年的報告指出,臺灣在末期腎病變的發生率及盛行率呈上升之趨勢,和美日並列前三名,然而,受限於傳統的研究上,只將衰弱症用於高齡病患的評估,而將末期腎病變病人排除在衰弱症的適用範圍之外,造成民眾及醫療人員對於末期腎臟病與衰弱症相關性認知不足。
目的:了解末期腎病變患者有無透析治療與衰弱症之間的相關性。
方法:本研究採橫斷式研究設計,針對北部某區域醫院之慢性腎臟病第五期病人及透析病人為研究對象,根據選樣標準,共取得91位符合收案條件且同意參與研究並完成調查之有效樣本,以結構式問巻訪談及採物理測量方式進行病人手部握力與五公尺行走速度等資料收集,採用IBM SPSS Statistics 23.0 統計軟體進行資料處理與統計分析。
結果:慢性腎臟病第五期病人及透析病人其衰弱在統計學上是無顯著差異。在衰弱傾向組及衰弱組的風險因子,以日常生活活動能力(ADL)(OR=.153,95%信賴區間.143-.163,p=.000;OR=.155,95%信賴區間.155-.155,p=.000)達顯著差異,顯示日常生活活動功能變項(ADL)愈高,衰弱風險愈低。
結論:根據本研究發現,雖然慢性腎臟病第五期病人及透析病人其衰弱在統計學上是無顯著差異,但對於血液透析患者我們不能低估會發生衰弱的風險,是值得去重視的,建議醫療專業人員未來應加強瞭解衰弱的基本概念,藉由此概念對於未來在慢性腎臟病第五期及透析病人推廣上,將能幫助醫療團隊及早辨別這些高危險群的病人,提供適當的治療與介入措施,降低發生衰弱之風險,讓病患有更好的生活品質。
Background:According to a 2015 report from the United States Renal Data System, USRDS, The incidence and prevalence of end-stage renal disease in Taiwan is on the rise, ranking the top three with the United States and Japan. However, traditional research only frailty in elderly patients assessment, excluding patients with end-stage renal disease, causing the public and medical staffs lacks of awareness of the correlation between end-stage renal disease and frailty.
Objectives:To understand the correlation between frailty and end-stage renal patients with or with out dialysis trerapy.
Methods:This study adopts a cross-sectional study design, and the intentional sampling method targeting the end-stage kidney patients in a regional hospital in New Taipei City. According to the selection criteria, in a totality of 91 valid samples that meet the acceptance criteria and agree to participate in the study and complete the survey were obtained. Structured questionnaire interviews and physical measurements were used to collect the patients’ grip strength and five-meter-walking speed. The data was processed and analyzed via using IBM SPSS Statistics 23.0 software.
Result:There is no statistically significant difference in the weakness of patients with chronic kidney disease stage 5 and dialysis patients. A significant difference in ADL (OR=.153,95% CI .143-.163,p=.000;OR=.155,95% CI .155-.155,p=.000) showed that the higher the daily activity function variable (ADL), the lower the risk of frailty.
Conclusion:According to this study, Although there is no statistically significant difference in the weakness of patients with stage 5 chronic dialysis patients and dialysis patients, But for hemodialysis patients, we must not underestimate the risk of frailty, which is worthy of attention.It is suggested that medical professionals should strengthen their understanding of the basic concepts of frailty to promote the patients with end stage renal disease in the future. Which helps the medical team to identify these high-risk groups of patients earlier, and provides appropriate treatment and intervention measures. Thus, alleviate the risk patients with end-stage renal disease being frailty, giving patients a better quality of life.
論文電子檔著作權授權書 i
論文審定同意書 ii
誌謝 iii
中文摘要 iv
英文摘要 v
目錄 vii
圖目錄 ix
表目錄 x
第一章 緒論 1
第一節 研究背景與重要性 1
第二節 研究目的 3
第三節 名詞界定 4
第二章 文獻探討 6
第一節 認識末期腎病變及腎臟替代療法 6
第二節 衰弱的概念 8
第三節 末期腎病變患者與衰弱症相關性 13
第四節 末期腎病變患者中有無透析治療與衰弱症之間的相關風險因子 20
第三章 研究設計與方法 23
第一節 研究設計 23
第二節 研究架構 24
第三節 研究假說 24
第四節 研究對象 26
第五節 研究工具 27
第六節 研究步驟 33
第七節 資料處理及分析方法 35
第四章 研究結果 36
第一節 末期腎病變患者基本屬性之描述 36
第二節 末期腎病變患者中衰弱之現況描述 51
第三節 末期腎病變患者中有無透析治療與衰弱症之間的相關性分析 55
第四節 末期腎病患者有無透析發生衰弱症的相關風險因子分析 59
第五章 討論 67
第一節 末期腎病變患者基本屬性之現況與分析 67
第二節 末期腎病變患者中衰弱之現況與分析 71
第三節 末期腎病變患者中有無透析治療與衰弱症之間的相關性分析 73
第四節 末期腎病患者有無透析發生衰弱症的相關風險因子分析 75
第六章 結論 77
第一節 結論 77
第二節 研究限制 81
第三節 建議 82
參考文獻 83
中文文獻 83
英文文獻 89
附錄 98
附錄一 受訪者同意書 98
附錄二 研究問卷 99
附錄三 IPAQ臺灣活動量調查-短版問卷使用同意書 106
附錄四 人體研究倫理審查委員會同意書 107


圖目錄
圖3-2 研究架構 24


表目錄
表1 衰弱判定標準定義 9
表2 修正衰弱判定標準定義 31
表4-1-1 末期腎病變患者人口學特性變項分佈 39
表4-1-2 末期腎病醫療特性變項分佈 42
表4-1-2 末期腎病醫療特性變項分佈(續) 47
表4-1-3 末期腎病身心功能變項分佈 50
表4-2 末期腎病變患者衰弱指標之描述 53
表4-3-1 末期腎病變患者有無透析治療與衰弱相關性 56
表4-3-2 透析方式在衰弱之差異性 58
表4-4-1 自變項共線性診斷結果 59
表4-4-2 末期腎病患者有無透析發生衰弱多項式邏輯斯迴歸分析結果 62
表4-4-2-1末期腎病患者不同透析模式發生衰弱多項式邏輯斯迴歸分析結果 63
表4-4-4 末期腎病患者有無透析發生衰弱二元邏輯斯迴歸分析結果 65
表4-4-4-1 末期腎病患者不同透析模式發生衰弱二元邏輯斯迴歸分析結果 66
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