| Abstract: | 背景：透析中低血壓為血液透析治療最常見之合併症，造成透析劑量不足等不良結果，需多元有效介入處置以降低透析中低血壓發生率。研究目的：針對腎衰竭患者改善血液透析中低血壓發生率多元處置之成效探討，進行實證研究文獻之分析與統整，並提出綜合性結論報告。研究方法：依系統性文獻回顧之步驟，使用intradialytic hypotension, treatment/intervention/management, patients with renal failure關鍵字，搜尋Cochrane Library、PubMed、MEDLINE Ultimate、CINAHL Ultimate英文電子資料庫，與台灣碩博士論文系統資源、Airiti Library華藝線上圖書館中文資料庫，排除不符研究主題與重複之文獻，採用CASP進行文獻品質評估，納入八篇探討透析中低血壓處置之研究，進行系統性回顧；文獻搜尋時間至2023年3月31日為止。研究結果 :統整八篇研究結果顯示五項處置可達改善透析中低血壓成效，包括：口服補充L-carnitine 4200毫克/每週，且用藥時間12週以上；使用壓力彈性襪或間歇性氣動腿部加壓裝置於下肢加壓20-45 mmHg促進血液回流；使用穴位灸貼於二側K11(湧泉穴)與CV4(關元穴)；或透析中輸注Mannitol 25克/小時，皆可減少透析中血壓下降或低血壓發生。結論 :五篇實證研究顯示具成效之介入處置，可作為醫護人員處理透析中低血壓事件發生時之參考。
Objectives:Intradialytic hypotension during dialysis is the most common complication of hemodialysis, which may result in adverse outcomes such as inadequate dialysis. It required multiple approaches to intervention effectively to reduce the occurrence of intradialytic hypotension.Purpose:This study aims to investigate the effects of management on multiple approaches to improving the incidence of intradialytic hypotension among patients with renal failure. Apply the systemic review and integrate the evidence-based clinical study to summarize a comprehensive conclusion.Methods:Following the steps of the systematic review process, using the keywords of intradialytic hypotension, treatment/intervention/management, and patients with renal failure, searched the four English electronic databases of Cochrane Library, PubMed, MEDLINE Ultimate, and CINAHL Ultimate, and two Chinese databases of the Taiwan Master and Doctoral Dissertation System Resources, Airiti Online Library: CEPS Chinese Electronic Journal Database, excluding inconsistent research topics and duplicate literature, after using CASP as tool to evaluate the quality of research, included eight studies on the management of intradialytic hypotension, conducted a systematic review to explore the effects of management on improving intradialytic hypotension among patients with renal failure. The publication duration of being researched references for this study was until March 31, 2023.Results:Five of study reached statistically significant differences, showing that it can be effective in improving intradialytic hypotension; including oral supplementation of L-carnitine 4200 mg/week with a duration exceeding 12 weeks; applying the elastic compression stockings or the intermittent pneumatic compression device on the lower extremities by 20-45 mmHg to promote blood return; use herbal acupoint therapy on the K11(Yongquan) in bilateral and CV4(Guanyuan) points; or infuse 25 g/hour Mannitol during dialysis can result in less blood pressure decreased, or the incidence of intradialytic hypotension during dialysis.Conclusions:Five of the evidence-based research demonstrate the efficacy of the intervention that can be used as references for clinical staff while managing intradialytic hypotension. |
