目錄目錄 Content 引言 01 引言 Introduction 慢性腎病的定義病徵及病狀 02 慢性腎病的定義病徵及病狀 Definition, Signs and Symptoms of Chronic Kidney Disease 慢性腎病的治療方法 05 慢性腎病的治療方法 Trea

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2 目錄目錄 Content 引言 01 引言 Introduction 慢性腎病的定義病徵及病狀 02 慢性腎病的定義病徵及病狀 Definition, Signs and Symptoms of Chronic Kidney Disease 慢性腎病的治療方法 05 慢性腎病的治療方法 Treatment Options for Chronic Kidney Disease 物理治療對病徵和病狀的處理 09 物理治療對病徵和病狀的處理 Physiotherapy Management on Signs and Symptoms of Chronic Kidney Disease 慢性腎病與運動 12 慢性腎病與運動 Chronic Kidney Disease and Exercise 如何開始運動 26 如何開始運動 Beginning of Exercise 防跌須知 28 防跌須知 Fall Prevention 總結總結 Conclusion 封底

3 引言引言 Introduction 當你確診為慢性腎病, 可能很擔心之後的生活, 對大部份人來說, 這是一個艱難的時刻, 而且還要處理情緒上和實際的問題雖然世界上有數以萬計的人患上慢性腎病, 卻仍可生活得活躍充實, 你不是孤單的但不幸地很多慢性腎病病人, 甚至醫護人員都誤以為你們不適宜進行運動, 但文獻記載運動有助你們穩定病情, 有更好的生活質素希望透過本小冊子, 你們會加深對慢性腎病的了解紓緩病徵及進一步認識正確的復康運動概念當你確診為慢性腎病, 可能很擔心之後的生活, 對大部份人來說, 這是一個艱難的時刻, 而且還要處理情緒上和實際的問題雖然世界上有數以萬計的人患上慢性腎病, 卻仍可生活得活躍充實, 你不是孤單的但不幸地很多慢性腎病病人, 甚至醫護人員都誤以為你們不適宜進行運動, 但文獻記載運動有助你們穩定病情, 有更好的生活質素希望透過本小冊子, 你們會加深對慢性腎病的了解紓緩病徵及進一步認識正確的復康運動概念 This may be a difficult time when you are diagnosed as chronic kidney disease (CKD), and there are many emotional and practical problems to handle. Although there are millions of people suffering from chronic kidney disease in the world, they still survive well and actively. Unfortunately, many physicians and even patients make the assumption that CKD patients should not do exercise. However, there is proven evidence that exercise can help you to stabilize your health and have better quality of life. Hope all of you would have a new insight on chronic kidney disease about physiotherapy on exercise and symptoms control through this booklet. 1

4 慢性腎病定義慢性腎病定義 Definition of Chronic Kidney Disease 腎臟是兩個至為重要的器官, 每一個腎都有大約一百萬個腎小球 ( 過濾器 ), 負責把血液中的廢物及多餘的液體變成尿液 ; 尿液貯在膀胱, 最後經過尿道排出體外腎臟同時也製造和調節荷爾蒙, 以幫助控制血壓製造紅血球, 並幫助形成健康的骨骼慢性腎病是腎細胞組織持續損壞超過三個月, 很多人都不知道自己有腎病, 直至腎功能喪失 70% 以上才發覺最常見的腎病原因是糖尿病高血壓以及腎小球發炎腎臟是兩個至為重要的器官, 每一個腎都有大約一百萬個腎小球 ( 過濾器 ), 負責把血液中的廢物及多餘的液體變成尿液清除 ; 尿液貯在膀胱, 最後經過尿道排出體外腎臟同時也製造和調節荷爾蒙, 以幫助控制血壓製造紅血球, 並幫助形成健康的骨骼慢性腎病是腎細胞組織持續損壞超過三個月, 很多人都不知道自己有腎病, 直至腎功能喪失 70% 以上才發覺最常見的腎病原因是糖尿病高血壓以及腎小球發炎 The kidneys are two vital organs. Each one has about one million of glomeruli (filters). They remove waste products and excess fluid from the blood as urine. They also produce and regulate hormones, which help to control blood pressure, produce red blood cells and develop healthy bones. Chronic kidney disease results from persisting kidney damage for more than 3 months. Many people are unaware of their kidney disease until over 70% of their kidney function has been lost. The most common causes of kidney failure are long standing diabetes mellitus, hypertension and glomerulonephritis. 腎臟腎臟 Kidney 尿道尿道 Ureter 膀胱膀胱 Bladder 2

5 病徵及病狀病徵及病狀 Signs and Symptoms 當腎功能嚴重損壞至剩下正常的15% 很多病人都會出現部份慢性腎病的病徵但程度不一當腎功能嚴重損壞至剩下正常的15% 很多病人都會出現部份慢性腎病的病徵但程度不一 When kidney function is severely impaired and reaches 15% of normal function or less, most patients will experience some symptoms of chronic kidney failure. However, these range from being relatively minor to quite severe: 足踝和雙足腫脹足踝和雙足腫脹 Lower limbs edema 氣促氣促 Breathlessness 疲憊疲憊 Fatigue 痕癢痕癢 Itchiness 皮膚乾燥皮膚乾燥 Dry Skin 食慾減退食慾減退 Loss of appetite 噁心噁心 Nausea 頭痛頭痛 Headache 睡眠質素下降如失眠睡眠質素下降如失眠 Poor sleep quality such as insomnia 記憶力和集中能力衰退記憶力和集中能力衰退 Poor memory and concentration p2 氣促氣促 Breathlessness 疲憊痕癢疲憊 Fatigue 痕癢 Itchiness 3

6 噁心噁心 Nausea 記憶力和集中能力衰退記憶力和集中能力衰退 Poor memory and concentration 食慾減退食慾減退 Loss of appetite p4 p4 睡眠質素下降如失眠頭痛頭痛 Headache 睡眠質素下降如失眠 Poor sleep quality such as insomnia 皮膚乾燥 p2 4 皮膚乾燥 Dry Skin 足踝和雙足腫脹足踝和雙足腫脹 Lower limbs edema

7 治療方法治療方法 Treatment Options 現今慢性腎病常見的治療方法有三種, 包括洗腎腎臟移植及保守療法現今慢性腎病的治療方法有三種, 包括洗腎腎臟移植及保守療法 Nowadays, there are three common treatment opinions for chronic kidney disease. They are dialysis, kidney transplantation and conservative care. 1. 洗腎洗腎 Dialysis 洗腎的方法有兩種 : 血液透析 ( 俗稱洗血 ) 和腹膜透析 ( 俗稱洗肚 ) 洗腎能緩解很多症狀, 讓病者的健康有顯著的改善及延長壽命, 但不會改善腎功能洗腎的方法有兩種 : 血液透析 ( 俗稱洗血 ) 和腹膜透析 ( 俗稱洗肚 ) 洗腎能緩解很多症狀, 讓病者的健康有顯著的改善及延長壽命, 但不會改善腎功能 There are two forms of dialysis: haemodialysis and peritoneal dialysis. Dialysis can prolong life but does not cure kidney failure.however, once you start dialysis, you will find a marked improvement in your well being as many of these symptoms will be minimized. ( 甲 ) 血液透析治療血液透析治療 Haemodialysis 血液透析的作用是過濾血液清除廢物, 並且把血液中多餘的水份排除血液在體外以透析機和人工腎臟 ( 透析膜 ) 清洗, 每次治療一般需時三至六小時, 通常每週二至三次, 但有些時候會更頻密及時間更長需要透過微創手術製造一個人工血管造瘻併發問題包括低血壓抽搐流血及疲憊 5

8 血液透析的作用是過濾血液清除廢物, 並且把血液中多餘的水份排除血液在體外以透析機和人工腎臟 ( 透析膜 ) 清洗, 每次治療一般需時三至六小時, 通常每週二至三次, 但有些時候會更頻密及時間更長需要透過微創手術製造一個人工血管造瘻併發問題包括低血壓抽搐流血及疲憊 Haemodialysis is designed to filter the blood of waste products and remove any excess fluid from the blood. The blood is cleansed outside the body using a haemodialysis machine and artificial kidney (dialysis membrane). Each treatment generally lasts between three to six hours and is usually performed two to three times per week but sometimes more often and for longer hours. An arterio-venous fistula over arm has to be created through a minor operation. Complications include hypotension, cramping, problems with bleeding and fatigue. ( 乙 ) 腹膜透析腹膜透析 Peritoneal Dialysis 腹膜透析需要每天進行, 過程是腹膜透析液通過腹膜導管流入腹腔, 廢物和多餘的水份從腹膜的微小血管流進透析液, 再通過腹膜導管從腹腔流出和血液透析不同, 腹膜透析是利用腹膜天然的內膜, 蓋著腹內器官在體內過濾血液併發問題包括導管位置發炎疝氣腰痛及肥胖腹膜透析需要每天進行, 過程是腹膜透析液通過腹膜導管流入腹腔, 廢物和多餘的水份從腹膜的微小血管流進透析液, 通過腹膜導管從腹腔流出和血液透析不同, 腹膜透析是利用腹膜天然的內膜, 蓋著腹內器官在體內過濾血液併發問題包括導管位置發炎疝氣腰痛及肥胖 Peritoneal dialysis filters the waste products and removes excess fluid from the blood vessels in the peritoneal membrane into the dialysis solution through Tenckhoff catheter in daily treatments. In contrast to haemodialysis, it filters the blood inside the body. It uses the peritoneum, a natural membrane that lines the cavity of the abdomen. Complications include problems with catheter site infection, hernias, low back pain and obesity. 最常見的腹膜透析有兩種 : 持續性非臥床腹膜透析和循環性全自動腹膜透析最常見的腹膜透析有兩種 : 持續性非臥床腹膜透析和循環性全自動腹膜透析 There are two common forms of peritoneal dialysis: Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis. 6

9 持續性非臥床腹膜透析持續性非臥床腹膜透析 Continuous Ambulatory Peritoneal Dialysis (CAPD) 腹膜導管腹膜導管 Tenckhoff catheter 腹膜腹膜 Peritoneum 腹膜透析液腹膜透析液 Dialysis Solution 在日間以人工操作進行互換過程稱為持續性非臥床腹膜透析每次互換 2-3 公升透析液需時約 45 分鐘, 互換過程在日間每 4-6 小時一次, 所以腹腔內經常都有 2-3 公升液體在日間以人工操作進行互換過程稱為持續性非臥床腹膜透析每次互換 2-3 公升透析液需時約 45 分鐘, 互換過程在日間每 4-6 小時一次, 所以腹腔內經常都有 2-3 公升液體 The exchanges are performed manually during the day, Each exchange of 2-3 litres of dialysis solution takes about 45 minutes to complete. These exchanges are done at intervals of 4-6 hours during the day. There is always a volume of 2-3 litres of fluid in your abdominal cavity. 循環性全自動腹膜透析循環性全自動腹膜透析 Automated Peritoneal Dialysis (APD) 洗腎也可以使用一部自動循環機通宵進行 8-10 小時這部機器在你睡覺的時候自動排出和灌入透析液循環機可以讓有工作或生活十分忙碌的人士更方便和容易洗腎洗腎也可以使用一部自動循環機通宵進行 8-10 小時這部機器在你睡覺的時候自動排出和灌入透析液循環機可以讓有工作或生活十分忙碌的人士更方便和容易洗腎 It is a peritoneal dialysis using an automated cycler machine performed for 8-10 hours overnight. This machine allows the dialysis solution to automatically fill and drain from the abdominal cavity while asleep. For people who are working or very busy, a cycler machine can make peritoneal dialysis much more convenient and manageable. 7

10 2. 腎臟移植腎臟移植 Kidney Transplant 腎臟移植是一個比較理想的治療腎臟移植是把一個人的一個腎臟用手術移植到慢性腎病患者身上一個移植的腎臟已經可以提供足夠的腎功能, 讓接受者保持健康與洗腎相比, 腎臟移植給你更佳的生活質素和更長的壽命但腎臟移植接受者需終生服用抗排斥藥腎臟移植是一個比較理想的治療腎臟移植是把一個人的一個慢性腎臟用手術移植到腎病患者身上一個移植的腎臟已經可以提供足夠的腎功能, 讓接受者保持健康與洗腎相比, 腎臟移植給你更佳的生活質素和更長的壽命但腎臟移植接受者需終生服用抗排斥藥 Transplantation of kidneys is the preferred treatment. A kidney transplant involves taking a kidney from the body of one person and implanting it surgically into the body of someone with CKD. One transplanted kidney provides enough kidney function to keep the recipient well. Compared to dialysis, a kidney transplant provides you with a much improved quality of life and life expectancy. Kidney transplant recipients are required to take immunosuppressive medications for the rest of their lives. 移植腎臟移植腎臟 Transplanted kidney 3. 保守治療保守治療 Conservative Treatment 保守治療主要是紓緩慢性腎病的病徵, 而非逆轉疾病的進程, 所以並不會進行上述所提及的治療, 主要以飲食和藥物控制為治療方法保守治療主要是紓緩慢性腎病的病徵, 而非逆轉疾病的進程, 所以並不會進行上述所提及的治療, 主要以飲食和藥物控制為治療方法 Conservative treatment of chronic kidney failure lets the disease runs its natural course and focuses on treating symptoms. Dialysis treatment is not used. Treatment relies on dietary management and medications. 8

11 物理治療對病徵和病狀的處理物理治療對病徵和病狀的處理 Physiotherapy Management on Signs and Symptoms of CKD 透過物理治療, 能舒緩慢性腎病患者一部份的病徵, 包括疲憊噁心水腫及痛症透過物理治療, 能舒緩慢性腎病患者一部份的病徵, 包括疲憊噁心水腫及痛症 Physiotherapy can relieve part of symptoms of CKD including fatigue, nausea, odema and pain. 1. 疲憊和噁心疲憊和噁心 Fatigue And Nausea i) 穴位按壓穴位按壓 Acupressure 身體有多個穴位有助減低疲憊及噁心, 適當的按壓或電療刺激穴位對紓緩病徵有幫助, 如下圖 : 身體有多個穴位有助減低疲憊及噁心, 適當的按壓或電療刺激穴位對紓緩病徵有幫助, 如下圖 : Acupressure or electrical stimulation to corresponding acupoints can relieve fatigue and nausea as diagram belows: 位置 ( 如圖 "X") 頻率次數 ii) 運動治療運動治療 Exercise Therapy 運動亦有助減低疲憊, 請參考慢性腎病與運動頁運動亦有助減低疲憊, 請參考慢性腎病與運動頁 Exercise can alleviate fatigue, please refer to "Chronic kidney disease and exercise" page

12 2. 痛楚痛楚 Pain i) 熱療慢性痛症或冰療急性痛症熱療慢性痛症或冰療急性痛症 Heat Therapy (Chronic Pain) or Ice Therapy (Acute Pain) 如對熱療或冰療有任何疑問可向物理治療師查詢如對熱療或冰療有任何疑問可向物理治療師查詢 Please don't hesitate to consult your physiotherapist if you have any enquiry. 注意事項注意事項 Precaution 每次治療為十五至二十分鐘如病人患處對冷熱感覺不敏銳請向物理治療師查詢使用的可行性每次治療為十五至二十分鐘如病人患處對冷熱感覺不敏銳請向物理治療師查詢使用的可行性 Each treatment takes 15 to 20 minutes. If there is any sensory deficit, please consult your physiotherapist. ii) 低頻透皮止痛電療低頻透皮止痛電療 TENS machine 低頻透皮止痛電療可以阻止痛楚的訊息傳遞至腦部減低痛楚的感覺低頻透皮止痛電療可以阻止痛楚的訊息傳遞至腦部減低痛楚的感覺 TENS machine can block pain signal to brain and decrease pain. 方法把電極貼放在觸痛點時間為十五至三十分鐘為確保安全使用有關觸發點的應用及注意事項請向物理治療師查詢切勿任意把電極貼上把電極貼放在觸痛點時間為十五至三十分鐘為確保安全使用有關觸發點的應用及注意事項請向物理治療師查詢切勿任意把電極貼上 10 Place electrodes on tender spots. It takes 15 to 30 minutes. Concerning the choice of trigger points, please consult your physiotherapist.

13 3. 水腫水腫 Oedema i) 手力治療手力治療 Massage 方法 : 推淋巴是用手幫助淋巴液沿著淋巴腺運行至淋巴結淺淋巴在皮膚表層, 按摩時要輕力深淋巴在大腿臀部肥厚的位置, 需要用較大力來按壓刺激淋巴系統的運行, 從而減少水份及脂肪的積聚, 達致消腫效果推淋巴是用手幫助淋巴液沿著淋巴腺運行至淋巴結淺淋巴在皮膚表層, 按摩時要輕力深淋巴在大腿臀部肥厚的位置, 需要用較大力來按壓刺激淋巴系統的運行, 從而減少水份及脂肪的積聚, 達致消腫效果 Lymphatic massage assists lymph circulation through lymph vessels to nodes. Lighter effort on superifical lymph vessels and heavier effort on deep lymph vessels located over thighs and buttocks region. 位置位置 Position 5 5 時間時間 Time 次數次數 Repetition 膝蓋內側淋巴腺 ( 在膝蓋內側 ) 膝蓋內側淋巴腺 ( 在膝蓋內側 )Medial knee 2. 鼠蹊部淋巴腺 ( 臀部的連接處 ) 2 2 鼠蹊部淋巴腺 ( 臀部的連接處 )Inguinal region 3. 腋窩淋巴腺 ( 在腋窩下方 ) 腋窩淋巴腺 ( 在腋窩下方 )Axilla 鎖骨淋巴腺 ( 鎖骨凹陷處 ) 鎖骨淋巴腺 ( 鎖骨凹陷處 )Clavicular region 5. 耳下淋巴腺 ( 在耳朵下方 ) 耳下淋巴腺 ( 在耳朵下方 )Behind ear ii) 運動治療運動治療 Exercise Therapy 請參閱慢性腎病與運動的主動式運動頁請參閱慢性腎病與運動的主動式運動頁 Please refer to "active mobilisation exercise" in "Exercise and chronic kidney disease" page

14 慢性腎病與運動慢性腎病與運動 Chronic Kidney Disease and Exercise 很多慢性腎病患者都會認為他們不適合或沒有能力做運動其實在專業醫護人員指導下慢性腎病病人亦可安全及有效地進行運動訓練和一般健康的人一樣適量運動對慢性腎病患者相當重要亦能提供以下好處改善心肺功能增加肌肉力量令日常活動有更好表現控制血壓和血糖舒展身心減低抑鬱機會經常和定期帶氧運動已被證明有助預防或治療嚴重和危及生命的慢性疾病如高血壓肥胖症心臟病二型糖尿病失眠及抑鬱症運動能為慢性腎病病人帶來極大益處而大部分腎病患者都適宜作適當的運動鍛鍊在計劃運動前請諮詢閣下之醫生及物理治療師的意見以確認身體狀況適合進行運動 P13 很多慢性腎病患者都會認為他們不適合或沒有能力做運動其實在專業醫護人員指導下慢性腎病病人亦可安全及有效地進行運動訓練和一般健康的人一樣適量運動對慢性腎病患者相當重要亦能提供以下好處改善心肺功能增加肌肉力量令日常活動有更好表現控制血壓和血糖舒展身心減低抑鬱機會經常和定期帶氧運動已被證明有助預防或治療嚴重和危及生命的慢性疾病如高血壓肥胖症心臟病二型糖尿病失眠及抑鬱症運動能為慢性腎病病人帶來極大益處而大部分腎病患者都適宜作適當的運動鍛鍊在計劃運動前請諮詢閣下之醫生及物理治療師的意見以確認身體狀況適合進行運動 Many patients with CKD think that they are not suitable for or capable of doing exercises, however, CKD patients can perform exercise safely and effectively under guidance of healthcare professionals. Same as normal healthy people, exercise is important and provides many benefits for CKD patients which include: Improve cardiopulmonary function. Improve muscle strength and thus your activities of daily living. Help to control blood pressure and blood sugar. Improve your mood and fight depression. Frequent and regular aerobic exercise has been shown to help preventing or treating serious and lifethreatening chronic conditions such as high blood pressure, obesity, heart disease, Type 2 diabetes, insomnia and depression. Exercise is highly beneficial for CKD patients, and most CKD patients are suitable for exercise training. Consult your physician and physiotherapist before starting exercise. 12

15 運動金字塔運動金字塔 Exercise Pyramid 靜態活動看電視靜態活動看電視 Sedentary Activities Watching TV 伸展活動拉筋瑜珈消閒活動種花購物伸展活動拉筋瑜珈 Flexibility - Stretching, Yoga 消閒活動種花購物 Leisure - Gardening, Shopping 肌力訓練每週兩次或以上器械沙包啞呤肌力訓練每週兩次或以上器械沙包啞呤 Strength Training - 2 or more times per week using Machines, Functional Training, Free weights 帶氧運動連續二十分鐘或以上加速心跳的運動跑步踏單車原地踏步急步走 P13 P13 帶氧運動連續二十分鐘或以上加速心跳的運動跑步踏單車原地踏步急步走 Aerobic Exercise - Continuous physical activity that increases heart rate for more than 20 minutes - Running, Biking, stepping, brisk walking 日常活動步行上落樓梯日常活動步行上落樓梯 Physical Activities - Walking, Stairs Walk P13 13

16 運動處方及小貼士運動處方及小貼士 Exercise Prescription 頻率頻率 Frequency 強度強度 Intensity 時間時間 Time 模式模式 Type/ Mode 漸進原則漸進原則 Rate of progression 運動頻率模式及時間運動頻率模式及時間 Frequency, Time and Type 日常活動帶氧活動肌力訓練伸展活動日常活動 Physical Activity 帶氧活動 Aerobic Activity 肌力訓練 Strength Training 伸展活動 Stretching Exercise 頻率每天每星期3-5次每星期2-3次每天頻率 Frequency 每天 Everyday 每星期3-5次 3-5 times per week 每星期2-3次 2-3 times per week 每天 Everyday 時間越多越好 20分鐘按需要按需要時間 Time 越多越好 As much as possible 20分鐘 20min 按需要 As required 按需要 As required P14 模式模式 Type P14 14 P14 P14

UTI (Urinary Tract Infection) - Traditional Chinese

UTI (Urinary Tract Infection) Urinary tract infection, also called UTI, is an infection of the bladder or kidneys. Urethra Kidney Ureters Bladder Vagina Kidney Ureters Bladder Urethra Penis Causes UTI

目錄目錄 Content 引言 01 引言 Introduction 慢性腎病的定義 病徵及病狀 02 慢性腎病的定義 病徵及病狀 Definition, Signs and Symptoms of Chronic Kidney Disease 慢性腎病的治療方法 05 慢性腎病的治療方法 Trea

目錄目錄 Content 引言 01 引言 Introduction 慢性腎病的定義病徵及病狀 02 慢性腎病的定義病徵及病狀 Definition, Signs and Symptoms of Chronic Kidney Disease 慢性腎病的治療方法 05 慢性腎病的治療方法 Trea