探討血液透析病人疲憊的變化型態及其預測因素

Exploring Fatigue Patterns and Associated Factors Among Patients on Hemodialysis

背景：血液透析病人的疲憊會受疾病本身及治療而有高低的波動，大多數的研究是以過去一週平均疲憊感受，來評估介入措施之成效，然而有研究指出，疲憊可分為透析後疲憊及持續性疲憊，若能先了解有那些不同性質疲憊族群，再測試措施的有效性，也許能更有效降低病人疲憊情況。
目的：探討血液透析病人於透析週期八天的疲憊變化型態及其預測因素。
方法：採前瞻性觀察法，以方便取樣，收案場所包括新北市三家醫院及一家診所之血液透析室，共有102位個案參與。個案在週期第一天透析時填寫人口學資料、台灣人憂鬱量表、血液透析社會支持量表、特質焦慮量表、匹茲堡睡眠品質量表及疲憊視覺類比量表，並於當日透析結束後開始，每天早、中、晚，連續八天填寫疲憊視覺類比量表；以查閱病歷收集血液生化檢驗值及透析間體重增加情形。
結果：研究結果呈現一週期八天的疲憊型態分為疲憊適應組、疲憊急遽變化組及持續疲憊組，以持續疲憊組占最多。當天透析後疲憊程度以疲憊適應組最低，急遽變化組最高；透析後疲憊上升程度（透析後減透析前的疲憊），以急遽變化組上升分數最多，持續疲憊組最低。睡眠品質、特質焦慮及社會支持中的醫護支持為區辨此三組型態的因素。
結論：臨床護理人員在透析過程給予個別性的支持、提供改善睡眠品質及緩和焦慮方法來協助病人降低疲憊。

Background: Fatigue in patients on hemodialysis varies based on disease and treatment situations. Most studies have assessed the effectiveness of interventions based on average fatigue during the past week. However, two different types of fatigue are identified: post-dialysis fatigue and continuous fatigue. Identifying different types of fatigue and related factors may facilitate the development of more-effective, type-specific measures to reduce patient fatigue.
Purpose: The purpose of this study was to explore fatigue patterns and predictors in patients on hemodialysis during their eight-day dialysis cycle.
Methods: A perspective, observational research design was adopted. One hundred and two patients were recruited from three hospitals and one hemodialysis clinic in New Taipei City. During the dialysis, patients answered a structured questionnaire that included a demographic datasheet, Taiwanese depression questionnaire, hemodialysis social support scale, trait anxiety inventory, Pittsburgh sleep quality index, and fatigue visual analogy scale. After dialysis on each day, patients completed the fatigue visual analogy scale for a period of eight consecutive days every morning, noon, and night. Biochemical data and inter-dialysis weight gain were collected from medical charts.
Results: This study found three distinct fatigue status groups: fatigue adaptation, rapid change and continuous fatigue. After the day of dialysis, fatigue level was the lowest in the fatigue adaptation group, followed by the continuous fatigue group. The rapid change group reported the highest level of fatigue. With regard to the degree of increase in fatigue after dialysis (fatigue score after dialysis minus fatigue score before dialysis), the rapid change group had the highest average increase in score after dialysis, while the continuous fatigue group had the lowest. Sleep quality, trait anxiety, and health caregiver support were also found to be predictors of group affiliation.
Conclusions: Nurses can provide individual social support interventions and methods to improve sleep quality and alleviate anxiety to reduce fatigue in patients on hemodialysis.