老年姿態性低血壓之臨床處理方案

Management of Orthostatic Hypotension in the Elderly

姿態性低血壓為老年人常見的健康問題之ㄧ，社區的老年人6~30%有姿態性低血壓，且盛行率隨著年齡增加。姿態性低血壓不僅會影響生活品質，甚至與老年致病率及死亡率的增加有關。本文以實證資料為基礎，建構臨床可參考的老年姿態性低血壓處理方案。內文將姿態性低血壓分為可恢復與不可恢復兩大類型，可恢復的姿態性低血壓主要針對疾病導因予以治療，以有效穩定血壓，若仍無法解決，則需進一步分析是否有不可恢復導因的存在。不可恢復的姿態性低血壓之治療方針，則以施行非藥物措施為優先，若仍無法達到治療目標，再考慮進行藥物治療。無論為可恢復或不可恢復導因，皆需穩定病人之急性問題，以利協助判斷，並遵守預防原則，減少誘導姿態性低血壓的相關因素。護理人員在此方案中扮演相當重要的角色，故期望藉由此方案之建構，提升臨床護理人員處理老年姿態性低血壓之能力，提供老年病人更適切的照護。

Orthostatic hypotension (OH) is a common health problem that affects 6% to 30% of the community-dwelling elderly. OH prevalence has been found to increase with age, influence the individual’s quality of life, and be associated with increased rates of morbidity and mortality. Referencing evidence-based reports, the aim of the present article was to construct an OH management protocol for the elderly with OH. Causes of OH can be generally divided into recoverable and unrecoverable types. Recoverable types refer to OH conditions in which the patient’s original health status can be restored following treatment. If such cannot be achieved, medical staffs must consider the possibility of an underlying unrecoverable factor. To treat unrecoverable OH, non-pharmacological intervention should be applied first. If such fails, then pharmacological interventions should be considered. Whether recoverable or unrecoverable, OH treatment should control acute health problems and follow general prevention principles. Nursing staffs play a crucial role in OH treatment. This proposed protocol may assist clinical nursing staffs to provide more appropriate elderly care.