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1 16 Peripheral Arterial Disease Nursing 血液透析患者之周邊動脈阻塞性疾病及其照護陳杏婉 1 劉雪娥 2* 摘要 : 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關鍵詞 : 篩檢周邊動脈阻塞性疾病護理策略 ankle-brachial index, ABI peripheral arterial occlusion disease, PAOD Eggers, Gohdes, & Pugh, 1999 Rajagopalan et al., 2006 O Hare et al., Fontaine Fontaine Classification 0.9 Norgren et al., % Selvin & Erlinger, % Cheung et al., ~32% Chen et al., 2008; Tsai, Tu, Yang, & Chen, 2010 Norgren et al., 2007 homocysteine *

2 17 Manns et al., 1999 Malnutrition Inflammation Atherosclerosis syndrome C Chen et al., % 100% Hirsch et al., 2006 Doppler ABI = ABI = Hirsch et al., Silvestro et al., 2006 O Hare & Johansen, 2001 Toe- Brachial Index, TBI Transcutaneous oxygen pressure, TCPO 2 O Hare & Johansen, 2001 skin perfusion pressure, SPP Okamoto et al., 2006; Shimazaki et al., 2008 pulse oximetry oxyhemoglobin saturation by pulse oximetry, SpO 2 Couse et al., 1994 Jawahar et al., % 86% Parameswaran, Brand, & Dolan, 2005 Intermittent claudication 5~ Geoffrey Rose WHO % 60 68% The Edinburgh Claudication Questionnaire 91.3% 99.3% Leng & Fowkes,

3 18 Peripheral Arterial Disease Nursing ~98.8% 47~86% Bendermacher et al., % 88.5% 2008 O Hare et al., 2004 Tsai, Tsao, Hsu, Lai, & Huang, /80mmHg 100mg/dL150mg/dL 40mg/dL 7% 3.5~5.5mg/dL 8.4~9.5mg/dL55mg 2 /dl 2 National Kidney Foundation, 2005 B12 Norgren et al., 2007 National Kidney Foundation, % Leng, Fowler, & Ernst, 2007 Cilostazol Cilostazol Clopidogrel 2007 Fontaine

4 19 Leng et al., [Chen, H. W. (2008). Screening and clinical correlates of peripheral arterial occlusive disease in hemodialysis patients. Unpublished master s thesis, Chang Gung University, Tao-Yuan County, Taiwan, ROC.] 1999 [Chen, C. J. (1999). Epidemiology: Principles and methods. Taipei City, Taiwan, ROC: Linking.] [Lai, Y. C., & Tseng, C. D. (2007). Medical treatment of peripheral arterial diseases. Taiwan Medical Journal, 50(2), 6 10.] Bendermacher, B. L. W., Teijink, J. A. W., Willigendael, E. M., Bartelink, M. L., Buller, H. R., Peters, R. J. G., et al. (2006). Symptomatic peripheral arterial disease: The value of a validated questionnaire and a clinical decision rule. British Journal of General Practice, 56(533), Chen, S., Su, H., Mai, H., Chen, J., Chen, C., Chang, J., et al. (2008). Associated risk factors for abnormal ankle-brachial index in hemodialysis patients in a hospital. The Kaohsiung Journal of Medical Sciences, 24(9), Cheung, A. K., Sarnak, M. J., Yan, G., Dwyer, J. T., Heyka, R. J., Rocco, M. V., et al. (2000). Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients. Kidney International, 58(1), Couse, N. F., Delaney, C. P., Horgan, P. G., O Keeffe, J., Joyce, W. P., Gorey, T. F., et al. (1994). Pulse oximetry in the diagnosis of non-critical peripheral vascular insufficiency. Journal the Royal Society of Medicine, 87(9), Eggers, P. W., Gohdes, D., & Pugh, J. (1999). Nontraumatic lower extremity amputations in the medicare end-stage renal disease population. Kidney International, 56(4), Hirsch, A. T., Haskal, Z. J., Hertzer, N. R., Bakal, C. W., Creager, M. A., Halperin, J. L., et al. (2006). ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease. Journal of the American College of Cardiology, 47(6), e1 e192. Jawahar, D., Rachamalla, H. R., Rafalowski, A., Ilkhani, R., Bharathan, T., Anandarao, N., et al. (1997). Pulse oximetry in the evaluation of peripheral vascular disease. Angiology, 48(8), Leng, G., Fowler, B., & Ernst, E. (2007). Exercise for intermittent claudication. Cochrane Database of Systematic Reviews, 2007(3). PMID: Leng, G. C., & Fowkes, F. G. (1992). The Edinburgh claudication questionnaire: An improved version of the WHO/Rose questionnaire for use in epidemiological surveys. Journal of Clinical Epidemiol, 45(10), Manns, B. J., Burgess, E. D., Hyndman, M. E., Parsons, H. G., Schaefer, J. P., & Scott-Douglas, N. W. (1999). Hyperhomocyst(e)inemia and the prevalence of atherosclerotic vascular disease in patients with ESRD. American Journal of Kidney Diseases, 34(4), National Kidney Foundation. (2005). KDOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Retrieved December 30, 2009, from org/professionals/kdoqi/guidelines_cvd/guide10.htm Norgren, L., Hiatt, W., Dormandy, J., Nehler, M., Harris, K., Fowkes, F., et al. (2007). Inter-society consensus for the

5 20 Peripheral Arterial Disease Nursing management of peripheral arterial disease (TASC II). European Journal of Vascular and Endovascular Surgery, 33(1), O Hare, A., & Johansen, K. (2001). Lower-extremity peripheral arterial disease among patients with end-stage renal disease. Journal of the American Society of Nephrology, 12(12), O Hare, A. M., Sidawy, A. N., Feinglass, J., Merine, K. M., Daley, J., Khuri, S., et al. (2004). Influence of renal insufficiency on limb loss and mortality after initial lower extremity surgical revascularization. Journal of Vascular Surgery, 39(4), Okamoto, K., Oka, M., Maesato, K., Mano, T., Ikee, R., Moriya, H., et al. (2006). Non-invasive diagnostic modality for peripheral arterial occlusive disease in hemodialysis patients. Myakkangaku, 46(6), Parameswaran, G. I., Brand, K., & Dolan, J. (2005). Pulse oximetry as a potential screening tool for lower extremity arterial disease in asymptomatic patients with diabetes mellitus. Archives of Internal Medicine, 165(4), Rajagopalan, S., Dellegrottaglie, S., Furniss, A. L., Gillespie, B. W., Satayathum, S., Lameire, N., et al. (2006). Peripheral arterial disease in patients with end-stage renal disease: Observations from the dialysis outcomes and practice patterns study (DOPPS). Circulation, 114(18), Selvin, E., & Erlinger, T. P. (2004). Prevalence of and risk factors for peripheral arterial disease in the United States: Results from the national health and nutrition examination survey, Circulation, 110(6), Shimazaki, M., Matsuki, T., Yamauchi, K., Iwata, M., Takahashi, H., Sakamoto, K., et al. (2008). Measurement of skin perfusion pressure in hemodialyzed patients: Association with toe/brachial index. Dialysis & Transplantation, 37(11), Silvestro, A., Diehm, N., Savolainen, H., Do, D. D., Vogelea, J., Mahler, F., et al. (2006). Falsely high ankle-brachial index predicts major amputation in critical limb ischemia. Vascular Medicine, 11(2), Tsai, T. H., Tsao, N. W., Hsu, C. P., Lai, S. T., & Huang, C. H. (2004). Results of surgical treatment for peripheral arterial occlusive disease in women. Journal of the Chinese Medical Association 67(2), Tsai, Y. F., Tu, P. C., Yang, L. P., & Chen, C. A. (2010). Prevalence and correlation factors of peripheral arterial disease in hemodialysis patients defined by ABI. Acta Nephrologica, 24(1),

6 21 Peripheral Arterial Occlusive Disease and Its Care in Hemodialysis Patients Hsing-Wan Chen 1 Hsueh-Erh Liu 2 * ABSTRACT: 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. Key Words: screening, peripheral arterial occlusive disease (PAOD), nursing strategies. 1 RN, MSN, Clinical Nursing Teacher, Department of Nursing, Chang Gung Institute of Technology; 2 RN, PhD, Professor, School of Nursing, Chang Gung University. Received: January 8, 2011 Revised: February 13, 2011 Accepted: March 3, 2011 *Address correspondence to: Hsueh-Erh Liu, No. 259, Wen-Hwa 1st Rd., Kwei-Shan, Taoyuan County 33302, Taiwan, ROC. Tel: +886 (3) ext. 5243; sarah@mail.cgu.edu.tw

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<4D6963726F736F667420576F7264202D203035BA43A9CAB5C7B049BADCB177AACCAABAC0E7BE69B7D3C5402DB3AFBEE5AF5CA141B3AFA5C9B1D32E646F63> 慢性腎衰竭患者的營養照護陳曉珮陳玉敏 * 摘要營養不良的問題常見於慢性腎衰竭的患者, 且與心血管罹病率及死亡率有密切相關護理人員在面對此類患者逐年上升的情況下, 應具備營養照護的相關知識, 才能給予適當的營養介入, 以