李淑杏周怡華Yi-Hua Chou護理學系2026-10-289999-12-312020https://handle.ncl.edu.tw/11296/5z8e6fhttps://scholars.csmu.edu.tw/handle/123456789/34718背景：台灣末期腎臟疾病患者(End-stage-renal disease；ESRD)發生率為全球之冠。多數患者以血液透析延續生命，而透析品質與瘻管功能良好與否有莫大關聯。以自體動靜脈瘻管作為長期血管通路，雖有較低的感染率及併發症，卻可能因瘻管內狹窄造成血流量下降導致血管栓塞的後果。傳統理學檢查因過主觀於臨床難以推廣，鑒於有關瘻管功能狀態，臨床上目前未有良好效度之評估工具，陳炯毓醫師擬定瘻管評估量表(Matt’s score)及測量脈動波長度(Palpable Pulse Wave Length；PPL)來改善傳統理學檢查主觀判別結果的缺點，期盼未來臨床血液透析醫護人員能靈活應用，即時發現異常並及早處置。目的：本研究目的在於驗證瘻管功能評估量表及脈動波長效度。研究設計：以自體瘻管行血液透析病患為收案對象，研究者使用瘻管評估量表，測量脈動波長度及傳統理學評估評估門診透析患者瘻管功能後，以超音波稀釋技術(Ultrasound Dilution Technology；HDO3)測定瘻管內流量小於600ml/min視為異常，驗證其敏感度及特異性。自2017年8月至2018年1月於中部某醫學中心血液透析室收案，共收案133人。以SPSS20.0 統計軟體分析，含卡方檢定、二元邏輯斯迴歸分析及ROC曲線圖。結果：卡方檢定變項顯示瘻管內流量異常者與年齡、瘻管功能量表、PPL達顯著相關。以二元邏輯斯迴歸分析後，Kt/V數值異常者瘻管異常風險提升18.5倍、瘻管評估量表2分相較於4分的病患有更高的風險存在(OR：101.35)、脈動波長(PPL)4指幅的病患比7指幅有更高的風險比(OR：37.8)。以超音波稀釋技術測得血管內流量是否正常為基準，ROC 曲線圖分析瘻管評估量表、脈動波長數值發現；瘻管評估量表(Area under curve；AUC)：0.777，脈動波長(PPL)AUC：0.824，對比傳統理學檢查手臂上舉測驗及脈搏阻塞試驗其AUC：0.551及0.469，使用瘻管評估量表及脈動波長測量具有較好的預測價值。結論：研究結果顯示瘻管功能異常相關危險因子與尿素廓清率(Kt/V)數值異常有顯著相關，瘻管評估量表與脈動波長相比傳統理學檢查有更好的預測力，未來可提供血液透析醫護人員做為瘻管功能第一線評估工具使用。關鍵字：動靜脈瘻管、瘻管功能評估量表、脈動波長度Background: The incidence of end-stage renal disease in Taiwan is the highest in the world. Most patients choose to extend their life via hemodialysis. As a long-term vascular access for hemodialysis, autologous arteriovenous fistula can thrombose due to flow reduction caused by stenosis. Traditional physical examination is unsatisfactory such that it’s difficult to promote in clinical practice. At present, there is no good evaluation tool yet clinically; Dr. Chiung-Yu Chen has developed a fistula assessment scale and measurement of the pulse wavelength to overcome the poor discrimination from traditional physical examination to help dialysis care team to find out abnormality immediately.Purpose: Verify the validity of fistula function assessment scale and pulse wavelength.Study design: Hemodialysis patients under autologous arteriovenous fistulas were recruited in this study. After evaluating the fistula function of the outpatient dialysis patients via the fistula assessment scale, measurement of pulsation wavelength and traditional physical examination, Ultrasound Dilution Technology was carried out to verify the sensitivity and specificity with flow rate less than 600 mL/min was considered abnormal. A total of 133 patients were enrolled, and the results were analyzed by chi-square test, binary logistic regression and ROC curve.Results: The chi-square test showed that abnormal fistula flow is associated with age, the fistula function scale, and the wavelength of pulsations. Regression analysis revealed 18.5 times higher risk of abnormal fistula in the patients with Kt/V value abnormality, in patients with scores of 2 than those with scores of 4, and in patients with pulsation wavelength of 4 fingerbreadth than those with 7 fingerbreadth. In the ROC curve analysis of fistula assessment scale and pulsation wavelength, AUC of fistula assessment scale, pulsation wavelength, arm evaluation test, and obstruction test is 0.777, 0.824, 0.551 and 0.469, respectively.Conclusions: The risk factor of abnormal fistula function is related to urea clearance rate, and better prediction was associated with fistula assessment scale and pulsation wavelength as compared to physical examination. The strategies we demonstrated here can be used as first-line assessment tools for the hemodialysis medical staff in the future.動靜脈&#30267管&#30267管功能評估量表脈動波長度rteriovenous FistulaFistula function assessmentPulse Wave Lengththesis