以系統性文獻回顧探討遠紅外線維護血液透析患者自體動靜脈瘻管之成效

The Effectiveness of Far-infrared Therapy in Hemodialysis Patients with Arteriovenous Fistula: A Systematic Review

背景：台灣有超過85%的末期腎病變（end-stage renal disease, ESRD）病患接受血液透析治療，其中80%的病患使用動靜脈瘻管（arteriovenous fistula, AVF）進行血液透析。目前研究顯示使用遠紅外線治療（farinfrared therapy）對於AVF患者可有效提升血管的血流量及通暢性，而對於尚未開始透析之患者則可增進其瘻管的結構穩定，但目前國內卻缺乏系統性文獻回顧探討其成效。目的：本文透過系統性文獻回顧，整合遠紅外線用於血液透析患者自體動靜脈瘻管之成效。方法：以系統性文獻回顧法搜尋2014年2月前發表於國內外相關資料庫包括華藝中文資料庫、Cochrane Library、CINAHL、PubMed、MEDLINE、ProQuest等資料庫，使用關鍵字遠紅外線（far infrared therapy）及血液透析（hemodialysis）、遠紅外線（far infrared）及自體動靜脈瘻管（arteriovenous fistula），共98篇，選取符合篩選標準並排除重覆出現，共找出3篇遠紅外線介入之隨機分派之臨床實驗性研究，以modified Jadad scale評定其研究品質得分皆為3分。結果：本系統性文獻回顧結果發現，遠紅外線介入可顯著改善血液透析患者之AVF的通暢性及降低AVF功能不佳的比例。但目前文獻多侷限於本國研究，故結果是否可適用於不同族群，還需待更多研究進行探討。結論／實務應用：本文使用系統性文獻回顧，整合文獻結果，使用遠紅外線治療對於AVF之患者是可以有效達到提升血管血流量及通暢性，而對於尚未開始透析之患者則可增進其血管結構穩定性，此結果對於臨床應用極為可行，目前已有實證研究證據說明透析患者執行握球運動可以維持瘻管之壽命，但許多患者因為年老或是疾病關係無法正確執行握球運動，可能導致瘻管失敗或是功能不佳，此時遠紅外線治療的介入可能是可行的措施。

Background: Over 85% of end-stage renal disease (ESRD) patients receive hemodialysis and 80% of hemodialysis patients in Taiwan contract arteriovenous fistula (AVF). Studies have shown that using far infrared therapy (FIR) improves AVF by improving blood flow. However, the systematic literature reviews have been insufficient to make definite conclusions regarding the effectiveness of this intervention. Purpose: This paper uses a systematic review of the literature to evaluate the FIR intervention and to explore its effectiveness. Methods: Researchers searched the following five Chinese and English electronic databases for relevant articles: National Dissertations and Theses, Airiti Library, CINAHL, Cochrane Library, ProQuest, and PubMed/MEDLINE. Keywords including ＂far infrared therapy＂, ＂arteriovenous fistula＂, and ＂hemodialysis＂ were entered. The search was limited to articles published before February 2014. A total of 98 articles that matched the search criteria were extracted. Article topics were screened and repetitions of topics were removed. Three articles met the study inclusion criteria and were selected for further analysis. An assessment of the quality of these 3 studies using the Modified Jadad Scale earned a score of 3. Results: Findings of this systematic review show that FIR interventions improve blood flow to and from the AVF and that the intervention decreases AVF malfunctioning. Currently, literature on this topic is limited in Taiwan. Therefore, more evidence is needed to validate the findings of the current study. Conclusions/Implications for Practice: The results of the current study support the ability of patients with FIR to improve their AVF functions as well as the immediate clinical applicability of the suggested intervention. Although current empirical evidence supports the effectiveness of gripping a ball in maintaining AVF functions, many hemodialysis patients, due to age or illness, are not physically capable of doing this exercise. Therefore, FIR is a very good alternative measure.