心腎症候群的體液處置原則概論

Overview of the Fluid Management Strategy in Cardiorenal Syndrome

10.6142/VGHN.202006_37(2).0009

鍾雨珍(Yu-Chen Chung)；陳俞琪(Yu-Chi Chen)

心腎症候群 ； 液體管理 ； cardiorenal syndrome ； fluid management

榮總護理

37卷2期（2020 / 06 / 01）

184 - 191

繁體中文

心腎症候群是指一種心臟和腎臟相互依存的狀態，隨著病程進展，在心腎相互影響之下，出現心臟和腎臟功能的障礙，體內產生水分滯留。體液過多是患者反覆入院最常見原因，此問題不僅影響病人生活品質，更會延長住院日數，及增加死亡率。因此，擬定液體管理策略是照護此類病人重要照護議題。在讓體液達到平衡時，也需要防範脫水不當或循環血量減少引起的灌注不足，而造成遠端器官受損。根據臨床指標及系統性身體評估、設定合適的液體目標值，透過適當的臨床處置與照護介入，以維持適當體液容積，乃是照護心腎症候群病人的首要任務。由於目前國內針對心腎症候群液體管理相關論述與研究甚少，本文期望進一步統整心腎症候群體液調控機制的實證結果，提出有效的液體管理策略，作為實務照護應用時之參考。

Cardiorenal syndrome (CRS) refers to the state of interdependence between the heart and kidneys. When the functions of these organs are impaired through disease, fluids accumulate in the body due to the organs' mutual influence. Thus, excess water retention is the most common reason for rehospitalization among patients with CRS. This issue not only affects patients' quality of life but also increases their hospital stay and mortality rate. Therefore, the development of fluid management strategies is crucial for patients with CRS. When providing nursing interventions to promote fluid balance, improper dehydration and loss of circulating blood volume must be prevented because they can induce distant organ impairment through organ hypoperfusion. Therefore, maintaining a balanced fluid volume through proper clinical management is a priority for care in patients with CRS. This care should be based on objective clinical indicators, systematic physical examination, and the determination of a suitable fluid volume level. However, because few studies have investigated fluid management among patients with CRS, this review aimed to explain the mechanism of fluid regulation and integrate empirical assessment and management results by summarizing relevant studies and developing a fluid management strategy that can serve as a reference for nursing practice.

1. 陳俞琪,張博論(2016)。應用健康資訊科技於慢性腎臟病持續性照護之契機與反思。護理雜誌，63(2)，12-18。
   連結：
2. Aliti, G. B.,Rabelo, E. R.,Clausell, N.,Rohde, L. E.,Biolo, A.,Beck-da-Silva, L.(2013).Aggressive fluid and sodium restriction in acute decompensated heart failure: A randomized clinical trial.JAMA Internal Medicine,173(12),1058-1064.
3. Chang, H. Y.,Wang, C. C.,Wu, Y. W.,Chu, P. H.,Wu, C. C.,Hsu, C. H.,Yin, W. H.(2017).One-year outcomes of acute decompensated systolic heart failure in Taiwan: Lessons f rom TSOC -HF rEF registry.Acta Cardiologica Sinica,33(2),127-138.
4. Damman, K.,Tang, W. H. W.,Testani, J. M.,McMurray, J. J. V.(2014).Terminology and definition of changes renal function in heart failure.European Heart Journal,35(48),3413-3416.
5. Hudon, C.,Chouinard, M. C.,Lambert, M.,Diadiou, F.,Bouliane, D.,Beaudin, J.(2017).Key factors of case management interventions for frequent users of healthcare services: A thematic analysis review.BMJ Open,7(10),e017762.
6. King, A. J. L.,Johnson, R.,Cramer, H.,Purdy, S.,Huntley, A. L.(2018).Community case management and unplanned hospital admissions in patients with heart failure: A systematic review and qualitative evidence synthesis.Journal of Advanced Nursing,74(7),1463-1473.
7. Mahtani, K. R.,Heneghan, C.,Onakpoya, I.,Tierney, S.,Aronson, J. K.,Roberts, N.,Nunan, D.(2018).Reduced salt intake for heart failure: A systematic review.JAMA Internal Medicine,178(12),1693-1700.
8. Mullens, W.,Damman, K.,Harjola, V. P.,Mebazaa, A.,Brunner ‐ La Rocca, H. P.,Martens, P.,Coats, A. J.(2019).The use of diuretics in heart failure with congestion-a position statement from the Heart Failure Association of the European Society of Cardiology.European Journal of Heart Failure,21(2),137-155.
9. Palmer, B. F.,Clegg, D. J.(2020).Fluid overload as a therapeutic target for the preservative management of chronic kidney disease.Current Opinion in Nephrology and Hypertension,29(1),22-28.
10. Ponikowski, P.,Voors, A. A.,Anker, S. D.,Bueno, H.,Cleland, J. G.,Coats, A. J.,van der Meer, P.(2016).2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.European Journal of Heart Failure,18(8),891-975.
11. Ronco, C.,Kaushik, M.,Valle, R.,Aspromonte, N.,Peacock, W. F.(2012).Diagnosis and management of fluid overload in heart failure and cardio-renal syndrome: The“5 B”approach.Seminars in Nephrology,32(1),129-141.
12. Ronco, C.,McCullough, P.,Anker, S. D.,Anand, I.,Aspromonte, N.,Bagshaw, S. M.,Ponikowski, P.(2010).Acute Dialysis Quality Initiative (ADQI) consensus group. Cardio-renal syndromes: Report from the consensus conference of the acute dialysis quality initiative.European Heart Journal,31(6),703-711.
13. Thomas, B.,Matsushita, K.,Abate, K. H.,AlAly, Z.,Ärnlöv, J.,Asayama, K.,Vos, T.(2017).Global cardiovascular and renal outcomes of reduced GFR.Journal of the American Society of Nephrology,28(7),2167-2179.
14. Zannad, F.,Rossignol, P.(2018).Cardiorenal syndrome revisited.Circulation,138(9),929-944.
15. 陳亮恭(2018)。超高齡社會智慧醫療應用再進化。福祉科技與服務管理學刊，6(1)，81-87。

1. 嚴美華,蔡佩勳,陳資錞,胡靜文(2023)。照顧一位末期腎臟病個案選擇安寧緩和療護之護理經驗。新臺北護理期刊，25(2)，130-139。