水中浸泡對肝硬化併發腹水病患利尿排鈉之成效

Effects of Water Immersion on Diuresis and Natriuresis in Cirrhotic Patients Complicated with Ascites

本研究的目的在於探討水中浸泡措施對肝硬化併發腹水病患利尿排鈉的效果，及其對病患所產生之生理反應。研究為實驗法，採立意取樣方式選取兩家醫學中心共10位肝硬化併發腹水病患為研究對象。研究進行中，每位研究對象收案時間為期十天，其中前四天為實施水中浸泡措施前的觀察期， 第五到七天為浸泡日，浸泡後再持續觀察三天，以瞭解個案實施水中浸泡措施後利尿排鈉的效應。研究發現如下結果：（1）實施水中浸泡措施後個案之尿中鈉離子排出量與單次尿量增加、血漿腎素、醛酯醇濃度與尿滲透壓有下降現象，其中血漿醛酯醇濃度及尿滲透壓的改變達到統計上顯著的差異 （p< .01），表示實施水中浸泡措施後，個案皆產生立即性利尿排納效應。（2）個案在浸泡日與未浸泡曰之體重、腹圍及24小時尿量亦有變化，其改善程度可達每日尿量增加500cc、體重減輕0.5公斤、腹圍減少1公分。（3）於實施水中浸泡期間，個案血壓有輕微下降現象，但其降幅未達統計上有意義的差異，血壓變化於浸泡結束後立即恢復。脈搏及呼吸則無明顯變化，表示此浸泡措施為一安全的處置。本研究之結果顯示水中浸泡措施對肝硬化病人腹水之減輕具有良好成效且相當安全，因此水中浸泡措施是一項值得推廣的護理措施。

The aims of this study were to investigate the effect of water immersion on the improvement of diuresis and natreuresis in the cirrhotic ascites patient, and to understand the physical response in subjects under this treatment. Ten cirrhotic patients with ascites were recruited in this study. In order to avoid the extraneous effects on the water immersion, this study designed the first four days as the preparation period during which subjects received control diet in sodium and diuretic therapy. The fifth to seventh days were the treatment period during which water immersion was given, and the last three days were the observation period. The results of this study were shown in the followings: (1) There was statistically significant decrease in plasma aldosterone concentration and urine osmolality (p<0.01) before and after water immersion. (2) The effects on diuresis and natriuresis were also shown in the change of body weight (0.5-kg decrease per day), abdominal girth (1-cm decrease per day), and 24-hour urine volume (500-cc increase per day) immediately after immersion. (3) Vital signs including blood pressure, pulse rate and respiratory rate were also checked during water immersion. Blood pressures were slightly declined during water immersion, but the changes were statistically non-significant, and recovered soon after immersion. The changes in respiratory rate and pulse rate were also negligible. It is concluded that water immersion does have effects on diuresis and natriuresis and is safe in cirrhotic patients complicated with ascites. Researchers of this study suggest that water immersion can be considered as a nursing intervention for cirrhotic patients complicated with ascites.