臺灣博碩士論文加值系統

進入老年化的社會，腎臟疾病的流行率正在急劇增加，血液透析是目前最普及的透析治療，透析患者的死亡率居冠在心血管疾中，估計約有40%的病患死於心臟血管疾病，而病患的營養狀況、低白蛋白，死亡率相對增加；較長時間的透析間隔期間，其心律不整發病率會增加，也增加死亡率。如果可以探究影響腎臟病死亡的因素是那些，將對於防治其死亡率有所裨益。本研究的目的為分析末期腎臟病死亡的相關因素，以某桃園區域醫院為例，收集2016年1月至2021年6月之死亡透析患者相關分析，將分為年齡、性別、透析年限、是否有共病因子、抽血白蛋白指數、洗前尿素氮及洗後尿素氮、死亡前住院原因做分析；而為維持病患良好的透析品質，降低死亡率是值得探討的議題，故分析桃園某區域醫院透析患者死亡相關因素分析，以提早介入與治療來達有效降低死亡之發生。研究發現白蛋白低下及年齡是影響死亡因素之因子。

Entering an aging society, the prevalence of kidney disease has been rapidly increasing. Hemodialysis is a wildly used method of dialysis mo-dality.It is estimated that about 40% of patients who are under hemodialy-sis die of cardiovascular disease. The nutritional status of patients, low al-bumin, increase the mortality rate. during the longer dialysis interval, the incidence of arrhythmia will increase, but also increased mortality. If we can explore the factors that affect the mortality rate of kidney disease, the rate of death caused by kidney disease could be decreased. The purpose of this study is to analyze the relevant factors of death from end-stage re-nal disease. Take a regional hospital in Taoyuan as an example, dialysis patients who died from January 2016 to June 2021 was analyzed and col-lected. Data analyzed were comorbidity, blood albumin index, urea nitro-gen before and after dialysis, and cause of hospitalization before death. In order to maintain good dialysis quality of patients and reduce mortality, it is a topic worth of discussion.Therefore analyzing death-related factors of dialysis patients in Taoyuan Regional Hospital, and provide early inter-vention and treatment can effectively reduce the occurrence of death. The study found that low albumin are all factors that affect death rate.

目錄

中文摘要 i
Abstract ii
目錄 iii
圖目錄 v
表目錄 vi
第一章緒論 1
第一節研究背景與動機 1
第二節研究目的 2
第三節研究對象 3
第四節研究流程 3
第二章文獻探討 5
第一節慢性腎衰竭流行病學 6
第二節末期腎疾病國內外盛行率現況……………………………6
第三節末期腎疾病死亡相關危險因子 7
第三章研究方法 9
第一節研究範圍 9
第二節資料來源……………………………………………………9
第三節資料統計分析方法………………………………………..10
第四章結果分析 11
第一節樣本結構分析 11
第二節敘述性統計分析 14
第三節透析死亡相關因素………………………………………..15

第五章結論與建議 17
第一節研究結論 17
第二節研究建議及研究限制與未來研究方向 18
參考文獻 19

圖目錄
圖1 研究步驟 -4-
表目錄
表4-1樣本分佈統計表 12
表4-2敘述性統計分析表……………………………………………...14
表4-3透析死亡相關因素分析表 15

1.王慈蜂、陳杰峰、許永和、羅德毓、鍾國彪、邱文達(2007)。初次血液透析及腹膜透析適應症及其品質監測指標。內科學誌, 1(2), 20-38。
2.台灣腎臟醫學會(2020)。台灣腎病年報
https://lib.nhri.edu.tw/NewWeb/nhri/ebook/39000000465141/#p=28
3.吳秉勳、郭美娟(2014)。台灣高齡透析病患死亡率, 罹病率, 及醫療支出概況。腎臟與透析, 26(1), 7-10。
4.郭依婷、李佳駿、宋俊明(2019)。透析治療: 觀念演變及進展。內科學誌, 35(2), 60-88。
5.衛生福利部(2020)。109年死因統計結果分析 109年國人死因統計結果。
6.董萃英. (2006). 血液透析患者之營養評估. 臺灣腎臟護理學會雜誌, 5(1), 1-11.
7.王守玠, &楊得政. (2018). 慢性腎臟病患者常見之心血管疾病. 慢性腎臟病及其合併症: 治療與照護手冊, 23-32.

二、英文文獻
1.Bleyer, A., Hartman, J., Brannon, P. C., Reeves-Daniel, A., Satko, S. G., & Russell, G. (2006). Characteristics of sudden death in hemodi-alysis patients. Kidney international, 69(12), 2268-2273.
2.Choy, A. S. M., & Li, P. K. T. (2015). Sustainability of the peritoneal dialysis-first policy in Hong Kong. Blood purification, 40(4), 320-325.
3.Eknoyan, G., Beck, G. J., Cheung, A. K., Daugirdas, J. T., Greene, T., Kusek, J. W., Allon, M., Bailey, J., Delmez, J. A., Depner, T. A., Dwyer, J. T., Levey, A. S., Levin, N. W., Milford, E., Ornt, D. B., Rocco, M. V., Schulman, G., Schwab, S. J., Teehan, B. P., & Toto, R. (2002). Effect of dialysis dose and membrane flux in maintenance hemodialysis. The New England Journal of Medicine, 347, 2010-2019
4.Kimata, N., Tsuchiya, K., Akiba, T., & Nitta, K. (2015). Differences in the characteristics of dialysis patients in Japan compared with those in other countries. Blood Purification, 40(4), 275-279.
5.Jha, V., Garcia-Garcia, G., Iseki, K., Li, Z., Naicker, S., Plattner, B., & Yang, C. W. (2013). Chronic kidney disease: global dimension and perspectives. The Lancet, 382(9888), 260-272.
6.Kwong, V. W. K., & Li, P. K. T. (2015). Peritoneal dialysis in Asia. Kidney Diseases, 1(3), 147-156.
7.Moody, W. E., Edwards, N. C., Chue, C. D., Ferro, C. J., & Townend, J. N. (2013). Arterial disease in chronic kidney dis-ease. Heart, 99(6), 365-372.
8.Ma, L., & Zhao, S. (2017). Risk factors for mortality in patients un-dergoing hemodialysis: A systematic review and meta-analysis. International journal of cardiology, 238, 151-158.
9.Owen Jr, W. F., Lew, N. L., Liu, Y., Lowrie, E. G., & Lazarus, J. M. (1993). The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. New England Journal of Medicine, 329(14), 1001-1006.
10.Ponce, D., Gobo-Oliveira, M., &Balbi, A. L. (2017). Peritoneal dialy-sis treatment modality option in acute kidney injury. Blood purifica-tion, 43(1-3), 173-178.
11.Rhee, C. M., et al. (2018). Dialysis Prescription and Sudden Death.Seminars in Nephrology,38(6), 570-581.
12.Roy-Chaudhury, P., Tumlin, J. A., Koplan, B. A., Costea, A. I., Kher, V., Williamson, D., &Winkelmayer, W. C. (2018). Primary outcomes of the Monitoring in Dialysis Study indicate that clinically significant arrhythmias are common in hemodialysis patients and related to dia-lytic cycle. Kidney international, 93(4), 941-951.
13.Ritz, E., & McClellan, W. M. (2004). Overview: increased cardiovas-cular risk in patients with minor renal dysfunction: an emerging issue with far-reaching consequences. Journal of the American Society of Nephrology, 15(3), 513-516.
14.Stevens, L. A., Viswanathan, G., & Weiner, D. E. (2010). Chronic kidney disease and end-stage renal disease in the elderly population: current prevalence,　future projections, and clinical signifi-cance. Advances in chronic kidney disease, 17(4), 293-301.
15.Soucie JM, McClellan WM. Early death in dialysis patients: risk fac-tors and impact on incidence and mortality rates. J Am Soc Nephrol. 1996 Oct;7(10):2169-75. doi: 10.1681/ASN.V7102169. PMID: 8915977.
16.Webster, A. C., Nagler, E. V., Morton, R. L., & Masson, P. (2017). Chronic kidney disease. The lancet, 389(10075), 1238-1252.