降低血液透析病人之高血磷專案

Hyperphosphatemia Project on Lowering Serum Phosphate in Dialysis Patients

高血磷是透析病人最常發生，也是最易忽略問題。長期累積引發皮膚搔癢、腎性骨病變，甚至威脅病人生命，因此控制血磷＜6mg/dl已成目前重要課題。統計單位2012年7月病人高血磷比率佔28.7％，遠高於腎臟醫學會20％標準，引發作本專案動機，經分析原因為：病人不暸解高磷食物種類、未確實服用鈣磷結合劑、未依病人個別性進行護理指導、缺乏護理指導作業標準。實施對策為：制定高血磷護理指導手冊、高血磷學習餐墊、個別性護理指導、醫療團體衛教及公開表揚進步獎等，結果高血磷比率由28.7％降至17.5％，藉由創新高血磷學習餐墊及個別性指導，養成病人規律服藥習慣，成效顯著，期望本專案經驗提供其他透析院所照護指引。

High levels of serum phosphate in dialysis patients is one of the most common and most often neglected problems. Over time, it can lead pruritus, renal osteodystrophy and even death. Keeping serum phosphate below 6 mg/dl is therefore a top priority. In July, dialysis patients with hyperphosphatemia accounted for 28.7% of all patients and was higher than the 20% standard value announced by Taiwan Society of Nephrology. The project to lower serum phosphate in hemodialysis patients was therefore undertaken. Analysis identified the following contributing factors: 1) insufficient patient knowledge of high phosphorus foods; 2) irregular timing for the intake of calcium phosphate binders; 3) the lack of individual nursing guidance for patients; 4) the absence of standard operating procedure in nursing guidance. To deal with these factors, the following strategies were developed and practiced: 1) publishing of nursing instruction manuals on hyperphosphatemia; 2) production of table mats with hyperphosphatemia-related information; 3) providing individual nursing guidance; 4) inviting medical organizations to deliver patient education; and 5) public recognition for those who make significant progress in reducing the levels of serum phosphate. As a result, the percentage of patients with hyperphosphatemia dropped from 28.7% to 17.5%. Table mats with hyperphosphatemia-related information and individual guidance produced a significant improvement in regular medication by patients. The experiences and information provided in this project should therefore serve as references for dialysis centers.