腹膜透析病患水分控制改善專案

A Project for Improving Fluid Control among Peritoneal Dialysis Patients

傳統上認為腹膜透析病患的水分控制較血液透析病患為佳，但研究發現，多數腹膜透析病患的水分控制並不如想像中的好，常有體液容積過多的問題，甚至增加病患的死亡率。由於本室病患抗高血壓藥物使用率高於70%，平時亦可見部份病患出現水腫、高血壓、呼吸喘等症狀，引發對病患水分與血壓控制做進一步探討之動機。本專案經由組員腦力激盪及文獻查證，找出問題並擬定查檢表，歸納出影響腹膜透析病患水分控制因素，以80/20法則進行改善對策之擬定與執行。結果評值：病患「生物電阻分析法」檢測的進步率達75%；理想體重目標值達成率達57.1%；減少降壓藥劑量進步率達30%。本專案實施結果達到有效改善腹膜透析病患水分控制不當問題，進而減少病患用藥成本之效益。

It was long believed that fluid control in peritoneal dialysis patients was better than it was for hemodialysis patients. However, recent studies have demonstrated that approximately one fourth of all peritoneal dialysis patients have a fluid control problem, with or without clinical manifestation. In uremia patients, fluid retention plays a key role in the pathogenesis of hypertension and cardiovascular disease, which were well documented as constituting the main causes of death in this specific population. In our PD center, more than 70 percent of the patients require anti-hypertensive medication to control blood pressure, and some patients even have clinical symptoms such as leg edema or shortness of breath. We conducted this study to clarify the relation between fluid control and blood pressure. By means of questionnaire responses from prevalent PD patients, we identified several causes of fluid retention in PD patients and tried to resolve them. According to the results, 75% patients had fluid control improvement in bio-impedance analysis, 57.1% patients achieved ideal body weight and 30% patients decreased their anti-hypertensive drug dosage. In conclusion, the current study demonstrates that adequate fluid control in PD patients improves blood pressure control and decreases the anti-hypertensive drug dosage.