探討下肢穴位遠紅外線照射對血液透析患者下肢血液循環的影響

背景： 血液透析患者罹患周邊動脈疾病的盛行率在17%到48%之間，當下肢動脈硬化或阻塞時，會造成血液循環變差、下肢疼痛。近年來相關的研究證實遠紅外線具有改善血液循環的功效。因此，若能結合遠紅外線在穴位點上照射，使肌肉組織溫度升高，促使血液透析患者下肢微血管的擴張、改善血液循環，達到緩解周邊動脈阻塞性疾病臨床症狀的目的。目的： 本研究以遠紅外線治療儀照射於血液透析病人雙下肢穴位，探討其對血液透析病人的足部血液循環、周邊動脈疾病(peripheral artery occlusive disease, PAOD)症狀及愛丁堡跛行問卷(ECQ)和踝臂指數(Ankle-Brachial Index,ABI)數值的影響。方法： 本研究採類實驗重複測量設計，於2023年2月至2023年8月期間，以中南部某區域醫院之血液透析室病患為對象，招募實驗組及對照組各16位進行研究。以透析日W 1.3.5者為對照組，W 2.4.6者為實驗組。介入措施為運用遠紅外線照射於雙下肢穴位的方式，照射距離20公分，每次40分鐘，每週3次，為期6個月介入時間。於介入前、介入後3及6個月，以踝臂指數(Ankle-Brachial Index,ABI)測量工具、結構性問卷(包含基本資料、愛丁堡跛行問卷)、病歷資料查閱，進行兩組前後測資料的收集。資料以SPSS 22.0進行統計分析，比較兩組踝臂指數(Ankle-Brachial Index,ABI)數值、愛丁堡跛行問卷(ECQ)的變化及差異。研究結果： 在愛丁堡跛行問卷(ECQ)上，遠紅外線照射於下肢穴位上有持續改善的效果，實驗組於介入後6個月發生下肢跛行症狀的比例顯著低於介入前(p=0.014)，而對照組則於6個月後發生下肢跛行症狀的比例顯著高於介入前(p=0.045)；兩組在介入後6個月有顯著性差異(p=0.045)；在踝臂指數(Ankle-Brachial Index,ABI)數值，實驗組於介入後6個月ABI數值正常的比例顯著高於介入前(p=0.01)，對照組於介入後6個月ABI數值正常的比例顯著低於介入前(p=0.03)，雖然兩組在介入後沒有顯著性差異(p=1.000)。以GEE MODEL分析介入後踝臂指數(Ankle-Brachial Index,ABI)數值、愛丁堡跛行問卷(ECQ)，隨著介入時間組別的變化，在愛丁堡跛行問卷(ECQ)方面，發現在控制年紀、透析年資、糖尿病、尿毒素清除率、肌酐酸等變項後，於3個月檢測時實驗組與對照組差異達顯著水準(β=0.505, p=0.003)，而在6個月實驗組與對照組織差異亦達顯著水準(β=0.570, p=0.000)。但在踝臂指數(Ankle-Brachial Index,ABI)方面，發現兩組於6個月檢測時，改變幅度差異未達顯著性。結論與建議 運用遠紅外線照射於下肢穴位，可顯著改善血液透析病人下肢跛行症狀。但對踝臂指數(Ankle-Brachial Index,ABI)的影響未達顯著。建議未來可運用遠紅外線照射於下肢穴位處，藉以改善下肢之血液循環、痠痛麻冷的臨床症狀，進而提升長期血液透析病人的生活品質。

BackgroundThe prevalence of peripheral artery disease (PAD) in hemodialysis patients ranges from 17% to 48%. When there is arterial sclerosis or blockage in the lower limbs, it can lead to poor blood circulation and lower limb pain. Recent studies have confirmed the efficacy of far-infrared radiation in improving blood circulation. Therefore, if far-infrared radiation is applied to acupuncture points, raising the temperature of muscle tissues may promote the dilation of microvessels in the lower limbs of hemodialysis patients, improving blood circulation and alleviating clinical symptoms of peripheral artery occlusive disease (PAOD).Purpose This study aims to investigate the effects of far-infrared therapy applied to acupuncture points on the lower limbs of hemodialysis patients. The focus is on its impact on foot blood circulation, symptoms of peripheral artery disease (PAD), and the Edinburgh Claudication Questionnaire (ECQ) and Ankle-Brachial Index (ABI) values in hemodialysis patients.Method This study adopted a quasi-experimental repeated measures design from February 2023 to August 2023. The participants included patients from the blood dialysis unit of a regional hospital in the central-southern part of the country. Sixteen participants were recruited for both the experimental and control groups. The control group consisted of individuals undergoing dialysis on days W 1, 3, and 5, while the experimental group underwent dialysis on days W 2, 4, and 6. The intervention involved applying far-infrared radiation to acupuncture points on both lower limbs, with a radiation distance of 20 centimeters, 40 minutes per session, and three sessions per week, lasting six months. Measurements were taken before the intervention, as well as at 3 and 6 months post-intervention, using tools such as the Ankle-Brachial Index (ABI) measurement, structural questionnaires (including basic information and the Edinburgh Claudication Questionnaire), and a review of medical records. Data from pre- and post-intervention assessments for both groups were collected. Statistical analysis was conducted using SPSS 22.0 to compare the two groups' changes and differences in Ankle-Brachial Index (ABI) values and Edinburgh Claudication Questionnaire (ECQ) scores.Results On the Edinburgh Claudication Questionnaire (ECQ), there was a sustained improvement in the group that received far-infrared radiation on lower limb acupuncture points. The proportion of the experimental group experiencing lower limb claudication symptoms significantly decreased six months after the intervention compared to before (p=0.014). In contrast, the control group showed a significantly higher proportion of lower limb claudication symptoms six months after the intervention than before (p=0.045). There was a significant difference between the two groups six months post-intervention (p=0.045). Regarding the Ankle-Brachial Index (ABI) values, the experimental group showed a significantly higher proportion of normal ABI values six months after the intervention than before (p=0.01). The control group showed a significantly lower proportion (p=0.03). However, there was no significant difference between the two groups post-intervention (p=1.000). Using GEE MODEL analysis for post-intervention Ankle-Brachial Index (ABI) values and Edinburgh Claudication Questionnaire (ECQ), it was found that, after controlling for variables such as age, years of dialysis, diabetes, urea clearance rate, and creatinine, there was a significant difference between the experimental and control groups at three months (β=0.505, p=0.003) and six months (β=0.570, p=0.000) in terms of the ECQ. However, there was no significant difference in ABI values at six months.Conclusion and Recommendations Applying far-infrared radiation to lower limb acupuncture points significantly improves claudication symptoms in hemodialysis patients. However, the impact on the Ankle-Brachial Index (ABI) was not significant. It is suggested that in the future, the application of far-infrared radiation to lower limb acupuncture points could be employed to enhance blood circulation in the lower limbs and alleviate clinical symptoms of pain, soreness, and numbness. This, in turn, may improve long-term hemodialysis patients' overall quality of life.