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題 名 | 慢性腎功能不全的整體性醫療照顧之前景=New Perspectives in Integrated Medical Care of Chronic Renal Insufficiency |
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作 者 | 馮祥華; | 書刊名 | 內科學誌 |
卷 期 | 13:3 2002.06[民91.06] |
頁 次 | 頁117-127 |
分類號 | 415.74 |
關鍵詞 | 整體性醫療照顧; 慢性腎功能不全; 衰退進行速率; 腎功能保護; Integrated medical care; Chronic renal insufficiency; Progression; Renoprotection; |
語 文 | 中文(Chinese) |
中文摘要 | 過去30年來,慢性腎衰竭的患者在臺灣如同全世界一般,呈現驚人的倍數在增加,而成長人數的部份絕大多數是老年人,以及高血壓和糖尿病的患者。這些慢性腎衰竭的病人,一旦進入長期的透析治療來維持生命,必然消耗不呈比例且為 數可觀的國家醫療保健資源,並且持續的再發生其他併發症,因此他們的生活品質普遍低落。慢性腎衰竭來自於慢性腎功能不全,而慢性腎功能不全的患者,早就有許多的病理生理及新陳代謝的異常在變化進行,這些現象不僅會導致腎功能更加衰退,也可能在以後的時期,或透析治療期,增加其死亡率。早期發現早期治療腎功能不全的致病原因,可以減緩腎功能衰退的進行速率,並減少透析的需求。然而事實上,慢性腎功能不全的患者似乎是被遺忘的一群,腎衰竭透析前的醫療照顧品質並未受到整體醫界的注意。吾人特別複習並整理文獻上臨床的證據,期望表達最高程度的腎臟功能保護,其中包括早期發現腎臟病、腎功能不全 形成及衰退的危險因子、限制蛋白質的飲食、控制高血壓與心血管合併症對腎功 能的重要影響、高血脂症和貧血的角色、腎性骨失養病變、以及戒煙對腎功能的重要性。誠然,治療慢性腎功能不全是複雜的,並且需要多方面的同時進行,完全的目標達成絕對需要整體的醫界協助。也因此醫界與衛生醫療主管機關賣不容怠,務必儘速建立國家的政策目標,確實施行,來降低慢性腎病的發生率、罹病率與醫療費用。 |
英文摘要 | There has been a striking increase in the incidence of end-stage renal disease (ESRD) over the past 30 years worldwide, and the same as Taiwan. The growing proportion of elderly, hypertensive and diabetic patients mainly accounts for the total increase in the number of these patients admitted to renal replacement therapy. Patients with ESRD consume a disproportionate share of national health care resources, and continue to experience significant morbidity and a reduced quality of life. A number of physiological and metabolic changes may contribute not only towards progressive loss of renal function but also to increased mortality observed thereafter, during the dialytic phase. The detection and correction of these events may slow the progression of chronic renal insufficiency (CRI) and delay the need for dialysis. However, the quality of medical care prior to initiation of dialysis has received scant attention. I reviewed the literature clinical evidence in support of maximal renoprotective interventions, including early detection of renal disease, risk factors for the development and progression of CRI, dietary protein restriction, control of systemic hypertension and cardiovascular complications, treatment of hyperlipidemia and anemia, management of renal osteodystrophy, and smoking cessation. But treatment of CRI is complex and multifaceted, and the whole objectives should demand integrated medical care. It is our responsibility to setup a national goal to reduce the incidence, morbidity and health care costs of chronic kidney disease over the next decade. |
本系統中英文摘要資訊取自各篇刊載內容。