透析病人衰弱症之社區安寧療護

Community-based Palliative Care for Frailty in Dialysis Patients

10.6200/TCMJ.2015.12.SP.01

趙家德(Chia-Ter Chao)；許園欣(Yuan-Hsin Hsu)；何鈺婷(Yu-Ting He)；翁瑞萱(Ruey-Hsiuang Ueng)；洪毓謙(Yu-Chien Hung)；施至遠(Chi-Yuan Shih)；徐愫萱(Su-Hsuan Hsu)；賴俊夫(Chun-Fu Lai)；黃勝堅(Sheng-Jean Huang)

衰弱症 ； 慢性腎臟病 ； 末期腎病 ； 慢性透析 ； 安寧療護 ； chronic dialysis ； chronic kidney disease ； end-stage renal disease ； frailty ； palliative care

北市醫學雜誌

12卷附冊（2015 / 06 / 30）

1 - 8

繁體中文

近來高齡醫學界對於衰弱症這個名詞的研究日益增加，也逐漸認知到此一概念對於高齡病患的各種預後來說十分重要；然而衰弱症在慢性腎臟病以及末期腎病病患的重要性卻經常被低估。衰弱症指的是隨著年齡增長而出現的一種累積性健康缺陷，造成個體本身無法應付後續接踵而來的生理以及心理上的壓力，而篩檢衰弱症成為一種新興的預後預測方式。在慢性透析病患推動社區安寧時，經常需要探討到其預後問題，而傳統的預測模型十分複雜、導致許多家屬及病患無法理解；此時，衰弱症的存在與否對於這些透析病患、以及醫療照護人員而言，就有其重要性存在。在本篇綜述中，我們將由台大金山分院臨床經驗出發，以衰弱症的角度來切入社區安寧照護如何推動這項議題。

An increasing number of studies have been focusing on the clinical significance of frailty in geriatric medicine, and being frail is associated with poor prognosis in the elderly. However, the importance of frailty is constantly under-recognized among patients with chronic kidney disease or end stage renal disease. Frailty is a status of accumulating health deficits during the aging process, resulting in the loss of ability to deal with physical or psychological stress. Screening for frailty is now a promising tool for prognosis prediction, which is an integral component in community-based palliative care for renal patients. However, traditional prognostic modeling is incomprehensive for patients or their family members. At this point, frailty or not, might then be an additional indicator for renal patients and the healthcare professionals to foretell the outcome. In the current review, based on the clinical experiences of the medical staff in the National Taiwan University Hospital Jinshan branch, we discuss in depth the utility of frailty status in assisting the promotion of community-based palliative care for renal patients.