某區域教學醫院改善血液透析病人血比容專案

A Project to Improve Hemodialysis Patients' Hematocrit at a Regional Teaching Hospital

血比容（Hct）偏低是造成慢性腎衰竭病人活動力不佳、營養不良等影響生活品質的主要原因之一，同時也需要花費更高的醫療成本進行治療，因此提升血液透析病人之Hct即成為本血液透析室首要目標。經由分析發現造成病人Hct偏低的主要原因有：病人之鐵質不足、病人因肝素劑量不足及病人營養不良等問題。因此將目標訂為血液透析病人Hct＞30%之比率由改善前的26.09%提升至39.13%。解決辦法即為：成立專責小組進行病人鐵劑補充、採用全身肝素化以解決病人肝素劑量不足情形、以及設計營養評估表並加強個別飲食衛教。結果發現病人之Hct＞30%之比率提升為65.2%，除改善病人營養健康狀況外，並且有效降低醫療成本。

The lower index of Hematocrit (HCT) is a major reason to cause those patients with a chronic renal failure to become more dystrophy and weaken the vitality. These sequelae can not only affect the quality of life, but also spend more to carry out the related medical treatments. In view of this, we had drawn up a countermeasure to raise the HCT of patients with Hemodialysis. After our further analysis and study, there are three findings mainly as listed below to cause patients getting a lower index of HCT: lack of ferritin or heparine and dystrophy. In order to see an improvement, we targeted the percentage of patients getting the index of HCT more than 30% to rise up to 39.13% from the initial rate of 26.09%. We have also teamed up to proceed with the following measures to aim at the above object: To provide patients with a ferritin supplement; To provide patients with a heparine supplement; and To classify the patient's condition according to the checklist for nutrition, and provide individuals with the dietetic treatment specifically. Based on our records, the percentage of patients getting the index of HCT more than 30% has been risen up to 65.2% by those measures as stated above. The result will help to better patient's health status and reduce effectively the related costs of medical treatments as well.