提升血液透析病人血比容之專案

Improving the Hematocrit Levels of Hemodialysis Patients

本專案目的：希望將血液透析病人血比容大於26%的比率提升達90%及維持目標值血比容大於33%，以改善病人貧血問題。單位於2010年1月至9月的統計資料，病人血比容大於26%的比率平均只有85.5%，低於評鑑標準；血比容大於33%的比率平均占35.8%。主要原因為紅血球生成素採靜脈注射、鐵質缺乏、透析器凝固、血液流失、營養衛教成效不佳、疾病因素，導致病人貧血。藉由更改EPO為皮下注射、修訂鐵劑管理方式、修訂血液透析結束標準技術流程、護理指導後，血液透析病人血比容大於33%的比率提升至40.6%，血比容大於26%的比率提升至90.9%，EPO成本由901,530元降721,224元。

The purpose of this project was to increase the percentage of hemodialysis patients with a hematocrit (Hct) level of over 26% to 90% and maintain a target Hct of over 33% to alleviate anemia symptoms among patients. Unit records for January through to September, 2010, showed that only 85.5% of patients had a Hct above the accreditation threshold of 26%. Furthermore, only 35.8% patients had a Hct of over 35.8% from the main causes included intravenous injection of erythropoietin (EPO), lack of iron supplements, clotting in the dialyzer, bleeding, poor diet control and underlying disease. As a result, we used subcutaneous EPO injection, adjusted iron supplements, revised standard hemodialysis protocols, and nursing guidance. At end of this study, 40.6% patients had a Hct over 33% and 90.9% patients had a Hct above 26%. Total cost of EPO also decreased from NT$ 901,530 to NT$ 721,224.