部某醫學中心血液透析患者皮膚搔癢及處置之探討

本研究係描述血液透析患者皮膚搔癢之相關問題，以做為皮膚癢之護理實證參考。自民國90年7月至12月於中部某醫學中心接受血液透析的患者共88位為研究樣本。以問卷與訪談方式收集資料。結果顯示血液透析病人皮膚癢之發生比率為61.4％，以透析後一年內發生皮膚癢者居多（81.5％），癢的部位依序為全身、軀幹及肢體（55.5％、27.8％、16.7％），癢的程度則以中、重度為最多（83.3％），且有一半以上（59.3％）的病患主訴影響睡眠。病患自行對皮膚癢的處理方式以手抓搔最為常見（74%），而病患自認為有效的處理方式，包括擦拭清涼溶劑（100％）、按摩按壓（100％）、轉移注意力（100％）、冷敷（100％）、手抓搔（90％）、使用藥物（90%）及擦拭乳液（54％）等。因而可瞭解本研究之病患使用上述處理方法有其個別性需求，故建議護理人員照顧血液透析患者之皮膚癢，應給予病患完整性的評估，尊重其個別需求，給予不同的照護。
This study describes the issues related to pruritus and self-management in hemodialysis (HD) patients. Using questionnaire and direct interview, we collected data from 88 patients at a medical center in central Taiwan between July and December 2001. Our results indicate that 61.4% of the HD patients developed pruritus, most (81.5%) occurring within one year after HD treatment. Among the patients surveyed, the pruritus occurred on the whole body (55.5%), on the torso (27.8%), and on the arms and legs (16.7%). Most of the pruritic problems (83.3%) ranged from medium to severe, and more than half (59.3%) of the patients reported having sleeping problems. Most of the patients responded to the pruritus by scratching with hands (74%). According to the patients’ responses, the most effective means of alleviating the pruritus included application of refreshing astringent (100%), massage with compression (100%), distraction (100%), cold application (100%), scratching (90%), using medication (90%) and application of lotion (54%), etc. Since each HD patient has his or her own preferred ways of effectively relieving pruritic problems, we should provide comprehensive assessment for each patient and individualized care.