臺灣博碩士論文加值系統

一、研究目的
本研究旨在比較血液透析與腹膜透析兩種透析治療模式對環境的影響，特別是碳足跡與溫室氣體排放量。透過分析每次透析治療前、中、後各個流程，包括耗材與藥物的生產製造、運輸、治療過程中的能源消耗、水資源的消耗、廢棄物處理、廢水處理，以及醫療人員和病人的交通等環節，來確定哪種透析模式能更好地兼顧低碳環境友善與相同療效。
二、研究方法
本研究採用ISO 14067服務型碳足跡調查與生命週期評估法 (Life Cycle Assessment, LCA)來分析血液透析、連續性可活動性腹膜透析 (CAPD)與全自動腹膜透析 (APD)三種治療模式的碳足跡。針對血液透析，還進行了ISO 14064-1組織型溫室氣體排放調查，以確定碳排放熱點作為提出減碳策略的依據。
三、研究結果
研究結果顯示，血液透析的碳足跡最高，每人每年達到1,772.86 kg CO2-eq，主要來源為電力使用 (86.7%)，其次是病人交通 (7.7%)、耗材運輸 (3.8%)，及醫療人員通勤 (1.8%)。相較之下，連續性可活動性腹膜透析 (CAPD)的碳足跡最低，每人每年為85.56 kg CO2-eq，全自動腹膜透析 (APD)為309.53 kg CO2-eq。這顯示腹膜透析相對於血液透析更為環境友善。
四、結論
研究顯示腹膜透析的兩種治療模式比血液透析具有顯著較低的碳足跡，因而更為環境友善。在全球節能減碳的浪潮下，政府在制定公共衛生政策時應考慮環境影響，推動更環保的透析治療模式，如綠色透析，以實現醫療服務與環境保護的雙重目標。

I.Objective
This study aims to compare the environmental impacts of hemodialysis and peritoneal dialysis, particularly focusing on carbon footprint and greenhouse gas emissions. By analyzing each process before, during, and after dialysis treatment, including the production and transportation of consumables and medications, energy consumption during treatment, water usage, waste and wastewater management, and the transportation of medical staff and patients, the study seeks to determine which dialysis mode is more environmentally friendly while providing similar therapeutic efficacy.
II.Methods
The study employs ISO 14067 service-based carbon footprint assessment and Life Cycle Assessment (LCA) to analyze the carbon footprints of three treatment modalities: hemodialysis, continuous ambulatory peritoneal dialysis (CAPD), and automated peritoneal dialysis (APD). For hemodialysis, an additional ISO 14064-1 organizational greenhouse gas emissions investigation was conducted to identify carbon emission hotspots and propose carbon reduction strategies.
III.Results
The results indicate that hemodialysis has the highest carbon footprint, with an annual per-patient emission of 1,772.86 kg CO2-eq, primarily from electricity usage (86.7%), followed by patient transportation (7.7%), consumable transportation (3.8%), and medical staff commuting (1.8%). In contrast, CAPD has the lowest carbon footprint at 85.56 kg CO2-eq per patient per year, and APD at 309.53 kg CO2-eq. This demonstrates that peritoneal dialysis is more environmentally friendly than hemodialysis.
IV.Conclusion
The study shows that both CAPD and APD have significantly lower carbon footprints compared to hemodialysis, making them more environmentally friendly options. In the context of global efforts to reduce carbon emissions, it is recommended that governments consider environmental impacts when formulating public health policies and promote more sustainable dialysis treatment modalities, such as green dialysis, to achieve the dual goals of healthcare delivery and environmental protection.

論文審定書 i
誌謝 ii
摘要 iii
Abstract 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 1
第二節 研究動機 5
第三節 研究問題 7
第四節 研究目的 11
第五節 研究流程 12
第二章 文獻探討 13
第一節 透析治療的介紹 13
第二節 透析治療對環境的衝擊 15
第三章 研究方法 21
第一節 個案醫院簡介 21
第二節 碳盤查概念說明 23
第三節 碳足跡與溫室氣體排放調查具體作法 27
第四章 資料分析與討論 31
第一節 ISO 14067服務型碳足跡(Service Carbon Footprint)調查 31
第二節 ISO 14064-1血液透析室組織型的碳盤查 37
第五章 討論與建議 40
第一節 具體發現與貢獻 40
第二節 血液透析治療碳足跡與溫室氣體排放研究結果討論與建議 41
第三節 腹膜透析治療碳足跡研究結果討論與建議 43
第四節 研究限制 44
第五節 總結 46
參考文獻 47

一、英文文獻
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Piccoli, G. B., Nazha, M., Ferraresi, M., Vigotti, F. N., Pereno, A., & Barbero, S. (2015). Eco-dialysis: the financial and ecological costs of dialysis waste products: is a ‘cradle-to-cradle’model feasible for planet-friendly haemodialysis waste management? Nephrology Dialysis Transplantation, 30(6), 1018-1027.
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Fresenius Medical Care. (2022). Sharing a Sustainable Tomorrow. Retrieved from: https://www.freseniusmedicalcare.com/fileadmin/data/com/pdf/Media_Center/Publications/Annual_Reports/FME_Annual_Report_2022_EN.pdf
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產品碳足跡資訊網。取自：https://cfp-calculate.tw/cfpc/WebPage/index.aspx