提升血液透析病人預防周邊動脈阻塞之照護完整率方案

Improving Preventive Care of Peripheral Arterial Occlusive Disease for Hemodialysis Patients

10.3966/172674042017091603002

賴妍伶(Yen-Ling Lai)；高玉貞(Yu-Chen Kao)；楊鳳凰(Feng-Huang Yang)；林懿如(Yi-Ju Lin)

血液透析 ； 周邊動脈阻塞疾病 ； 截肢 ； hemodialysis ； peripheral arterial occlusive disease ； amputation

臺灣腎臟護理學會雜誌

16卷3期（2017 / 09 / 01）

13 - 28

繁體中文

血液透析病人容易罹患周邊動脈阻塞疾病（Peripheral Arterial Occlusive Disease；PAOD），本專案目的為提高預防周邊動脈阻塞疾病照護完整率，經現況分析照護完整率不足的原因有：護理人員缺乏認知、護理指導工具不足、缺乏衛教標準流程、缺乏PAOD評估表、病人末梢循環不良、缺乏考核獎勵制度。專案改善措施：安排在職教育、製作PAOD護理指導單張及宣導短片、制定衛教標準規範、制訂PAOD評估表、使用暖暖襪及執行下肢運動計畫、訂定護理人員稽核制度及獎懲辦法。專案結果，護理人員認知由70分提高至100分，病人末梢循環不良評估降低了13.7％；罹患PAOD盛行率由24.6％降至21.5％，預防PAOD照護完整率，提升為90％，希望藉此結果有效減少血液透析病人截肢的發生，以提升病人生活品質。

Hemodialysis patients are prone to Peripheral Arterial Occlusive Disease (PAOD). The purpose of this project is to improve PAOD care integrity rate. Based on the analysis of current situation, the inadequacy in medical care is due to: lack of awareness of nursing staff, lack of care guidance tools, inexistence of standardized healthcare education procedures, inexistence of PAOD assessment/evaluation form, poor peripheral circulation in patients and lack of evaluation and incentive system. Improvement measures included in this project: provide on job education, produce PAOD care instruction leaflets and educational videos, formulate standards for healthcare education, elaborate PAOD assessment form, the use of warm socks and implementation of lower limb exercise plan, set up nursing staff audit system with rewards and punishments. Results of the project: awareness of nursing staff increased from 70 percent to 100 percent, peripheral circulation adverse assessment decreased by 13.7%; prevalence rate of PAOD dropped from 24.6% to 21.5%, preventive PAOD care integrity increased to 90%, hoping to reduce the occurrence of amputation in hemodialysis patients and thus enhance their quality of life.

1. Chen, J. H.,Chen, S. C.,Liu, W. C.,Su, H. M.,Chen, C. Y.,Mai, H. C.,Chang, J. M.(2009).Determinants of peripheral arterial stiffness in patients with chronic kidney disease in southern Taiwan.Kaohsiung Journal of Medical Sciences,25(7),366-373.
2. Garimella, P. S.,Hart, P. D.,O'Hare, A.,De Loach, S.,Herzog, C. A.,Hirsch, A. T.(2012).Peripheral artery disease and CKD: a focus on peripheral artery disease as a critical component of CKD care.American Journal of Kidney Diseases,60(4),641-654.
3. Tsai, Y. F.,Tu, P. C.,Yang, L. P.,Chen, C. A.(2010).Prevalence and Correlation Factors of Peripheral Arterial Disease in Hemodialysis Patients Defined By Ankle-Brachial Index (ABI).Acta Nephrologica,24(1),42-46.
4. 于會功,胡國琦(2013)。糖尿病合併周邊動脈阻塞疾病病人之復健運動訓練~訓練計劃與最新實證。中華民國糖尿病衛教學會會訊，3，6-12。
5. 余法昌(2013)。下肢動脈阻塞性疾病。中華民國糖尿病衛教學會會訊，9(3)，21-24。
6. 吳淑榕,馮兆康,高玉貞,黃文鈺,高銘聰,高清添(2010)。血液透析病患周邊動脈疾病盛行率及相關因素。澄清醫護管理雜誌，6(2)，13-20。
7. 林盈利,蘇育德,林益卿(2010)。周邊動脈疾病。家庭醫學與基層醫療，25(5)，188-195。
8. 翁妙妃(2014)。一位血液透析病人合併周邊動脈阻塞截趾之護理經驗。臺灣腎臟護理學會雜誌，13(4)，53-68。
9. 陳杏婉,劉雪娥(2011)。血液透析患者之周邊動脈阻塞性疾病及其照護。護理雜誌，58(2)，16-21。