伸展運動介入血液透析患者預防不寧腿症候群再復發之實證照護

Evidenced-Base Nursing of StretchingExercise Intervention for Prevention ofRecurrence of Restless Leg Syndrome inPatients with Hemodialysis

台灣地區末期腎臟疾病盛行率及發生率均為世界第一位，不寧腿症候群(restless legssyndrome, RLS)是一種感覺運動神經學障礙，血液透析患者合併RLS發生率高達6.6-70%不等，約有20%患者因RLS症狀干擾而中斷治療使得血液透析效果不佳。本個案是一位診斷末期腎臟病合併不寧腿症候群之血液透析患者，因不寧腿症候群導致透析治療受到中斷，筆者運用實證護理探討伸展運動是否可避免病人於血液透析治療過程，發生不寧腿症候群而中斷透析治療。 故搜尋CINAHL, Cochrane library, Medline, PubMed等資料庫，使用關鍵字''hemodialysis '','' stretching exercises'', '' restless legssyndrome''之MeSH term及同義字，搜尋2015年1月至2020年1月近五年之英文實證文獻，最後萃取出2篇與血液透析患者不寧腿症候群與伸展運動文章納入分析，並以隨機研究評讀工具查核文獻以比較研究之完整性與品質，結果發現血液透析過程最後2小時，進行30分鐘伸展運動能有效預防不寧腿症候群。且伸展運動不具侵入性且無經濟負擔，做為輔助療法個案接受度高且可獨立操作。期望藉此實證案例照護經驗，提供醫護人員依據臨床照護需求，運用實證技巧找出最佳照護方式。

The prevalence and incidence of end-stagekidney disease in Taiwan are both top 1 aroundthe world. Restless legs syndrome (RLS) is asensorimotor neurological disorder, and theincidence of patients undergoing hemodialysiscomplicated with RLS is as high as 6.6-70%.Approximately 20% of patients discontinuetreatment due to the interference of RLS,leading to poor hemodialysis effect. Thecase is a hemodialysis patient with end-stagekidney disease complicated with RLS whohad to discontinue treatment due to RLS. Theauthor used empirical nursing to investigatewhether stretching exercise can preventpatients from discontinuing hemodialysisprocess. Therefore, this study searcheddatabases, such as CINAHL, Cochrane library,Medline, and PubMed, and used the Keywords''hemodialysis'', ''stretching exercises'',''restless legs syndrome'' MeSH terms andsynonyms to search empirical literature inEnglish from January 2015 to January 2020(in recent 5 years). Lastly, this study extracted2 studies associated with patients undergoinghemodialysis complicated with RLS and stretching exercise for analysis. Moreover,this study used CASP to inspect literature andcompare the integrity and quality of studies.The results showed that the implementationof 30-minute stretching exercise in the final 2hours of hemodialysis effectively preventedRLS. Besides, stretching exercise is noninvasiveand does not create any economicburden. Stretching exercise can be highlyaccepted as an adjuvant therapy and operatedindependently. Hopefully, the empiricalnursing experience may serve as referencefor medical and nursing personnel to meet theclinical care needs and apply empirical skillsto find the best care method.