血液透析患者之周邊動脈阻塞性疾病及其照護

Peripheral Arterial Occlusive Disease and Its Care in Hemodialysis Patients

血液透析患者罹患周邊動脈阻塞性疾病之盛行率較一般族群高出數倍，且是截肢的主要原因。罹患周邊動脈阻塞性疾病患者之心血管疾病住院率及死亡率也比未罹患者高。但目前普遍用來篩檢周邊動脈阻塞性疾病的肱踝壓力指數測量，應用於血液透析族群卻會因此族群廣泛性血管鈣化而低估此族群盛行率，且易忽略早期罹病的患者。文獻指出利用上下肢脈動氧血紅素飽和度測量及「愛丁堡跛行問卷」是簡便易行的篩檢方式，若能合併肱踝壓力指數篩檢，可增加篩檢之有效性。若能早期發現疾病，協助矯正危險因子，提供藥物治療及運動復健，可改善患者行走功能及減少心血管事件死亡率。

The prevalence of peripheral arterial occlusive disease (PAOD) in hemodialysis patients is several times higher than among the general population, and is the main reason for amputations in this group. Patients with peripheral arterial occlusive disease face higher hospitalization and mortality rates associated with cardiovascular disease than non-PAOD patients. The ankle brachial index (ABI) is a widely used PAOD screening tool that may under-estimate PAOD prevalence in the hemodialysis population in the presence of extensive vascular calcification. Studies have demonstrated oxygen saturation in the upper and lower limbs and the “Edinburgh Claudication Questionnaire “ as simple screening methods that, in combination with ABI, can increase screening test effectiveness. Early PAOD detection, risk factor modification, medical treatment, and exercise rehabilitation therapy can improve walking function and reduce mortality in PAOD patients.