長期血液透析病人血液分析之研究-以南部某區域教學醫院為例

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Title:	長期血液透析病人血液分析之研究-以南部某區域教學醫院為例 A Study of Blood Analysis of Long Term Hemodialysis Patients - a Regional Teaching Hospital in Southern Taiwan
Authors:	林虹彤
Contributors:	醫務管理系陳俞成
Keywords:	血液學參數全血球計數血液透析貧血 hematologic parameter complete blood count hemodialysis anemia
Date:	2018
Issue Date:	2019-02-27 16:44:32 (UTC+8)
Abstract:	背景：慢性腎臟病（Chronic Kidney Disease, CKD）是全球新興的公共衛生問題。根據行政院衛生福利部統計資料（2017）顯示，2016年國人十大死因排名第九為腎炎、腎病症候群及腎病變，標準化死亡率12.4（每十萬人口）。根據美國腎臟資料系統（US Renal Data System, USRDS）統計資料顯示，我國2011年末期腎臟病（End-Stage Renal Disease, ESRD）發生率約為每百萬人口361人，高居全球第三位（USRDS, 2013）。血液透析（Hemodialysis, HD）為世界各國最廣泛使用的透析模式。血液學參數一般受到CKD嚴重度的影響，但血液學特徵很少被研究。目的：本研究目的為(1)分析長期血液透析病人之血液學變化，(2)探討長期血液透析對不同性別病人血液學變化的影響。方法：本研究以南部某區域教學醫院長期血液透析病人為研究對象，收集血液透析頻率達每周3次且六個月以上病人透析前血液常規檢查之全血球計數（Complete Blood Count , CBC）數據。研究資料收集期間為2015年1月1日到2015年12月31日，採用當年度每月透析前之CBC數據，進行?述性及推論性統計。但因檢驗資料例行備份疏忽，而遺漏8-10月CBC數據。結果：本研究結果顯示長期血液透析病人的血液學參數狀態大多為：WBC正常（3,000~5,000/l）、RBC低下（<4.0106/l）、輕度貧血（Hb : 7.0~12.0g/dL）、低Hct（< 33%）、PLT正常（15104~40104/ul）。貧血種類主要為正球性、正色性貧血，RBC大小正常（RDW-CV：11.5~14.5%）。血液透析病人於治療期間貧血盛行率介於92.7~94.2%，女性病人介於95.5~100%，男性病人介於86.5~89.9%。於血液透析治療期間，MCHC狀態與CBC檢查月份有統計上有顯著關聯（2=15.80，p < 0.05）；血液學參數值（RBC、Hb、Hct、MCV、MCHC、PLT及RDW-CV）對性別有統計上顯著差異（p < 0.001）。結論：研究顯示長期血液透析治療的病人貧血盛行率高，女性病人貧血盛行率高於男性；女性可能有較嚴重的腎性貧血，或較易發生發炎及感染的症狀。推測血液透析病人在治療期間定期進行血液常規檢查，可提供臨床醫師適當的血液學評估指標，有助於採取適當的預防及改善醫療措施。 Background: Chronic Kidney Disease (CKD) is a global emerging public health problem. According to the statistics of Department of Health and Welfare Department (2017) shows that the ninth cause of death in 2016 was nephritis, nephrotic syndrome and kidney disease; the standardized mortality rate is 12.4 (per 100,000 population). According to the US Renal Data System (USRDS) statistics, the incidence of end-stage renal disease (ESRD) of ROC in 2011 (about 361 people per million populations) was the third in the world (USRDS, 2013). Hemodialysis (HD) is the most widely used dialysis model in the world. Hematological parameters are generally affected by CKD severity, but hematological features are rarely studied. Objective: The purpose of this study was to (1) analyze the changes of hematological parameters in patients with long-term HD; and (2) to explore the effect of long-term HD of different gender of patients on hematological parameters. Methods: In this study, a long-term HD patient in a regional teaching hospital in southern Taiwan was studied. The complete blood count (CBC) data before dialysis was collected from hemodialysis patients, who had hemodialysis frequency 3 times a week and more than six months. Data collected period was from January 1, 2015 to December 31, 2015, using the pre-dialysis CBC data of the current year for descriptive and inferential statistics. However, due to negligence of routine backup of test data, CBC data from August to October were lost.Results: The results of this study showed that the hematological parameters of long-term hemodialysis patients were: normal WBC (3,000-5,000/l), low RBC (<4.0106/l), mild anemia (Hb : 7.0~12.0g/dL), Low Hct (<33%), normal PLT (15104~40104/ul). The main types of anemia are normocytic, Normochromia anemia, normal RBC size (RDW-CV: 11.5 ~14.5%). The prevalence of anemia in hemodialysis patients ranged from 92.7~ 94.2% during the treatment period, ranging from 95.5~100% in female patients and 86.5~89.9% in male patients. During hemodialysis treatment, there was a significant association between MCHC status and CBC examine month (p <0.05) and hematologic parameters (RBC, Hb, Hct, MCV, MCHC, PLT and RDW-CV) had statistically significant differences in gender (p <0.001). Conclusions: Studies have shown a high prevalence of anemia in long-term hemodialysis patients, and a higher prevalence of anemia in women than in men. Women may have more severe renal anemia, or more prone to inflammation and infection symptoms. Guessing hemodialysis patients routinely conduct routine blood tests during treatment, which may provide clinicians with proper hematological evaluation indicators and help to take appropriate preventive and remedial measures.
Relation:	電子全文公開日期：2023-12-31，學年度：106， 67頁
Appears in Collections:	[Dept. of Hospital and Health (including master's program)] Dissertations and Theses

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