透析患者周邊神經病變與睡眠品質相關性探討

Abstract

在透析患者的神經病變中，周邊神經病變是常見的其中之一，而其主要是以感覺、運動神經受損的混合症狀表現。本研究目的主要探討透析患者的周邊神經病變的特質及嚴重度及周邊神經病變性疼痛與患者睡眠品質之關係。研究設計採橫斷性、描述相關性研究法，以立意取樣於北部某醫學中心透析患者為研究對象，研究工具採用「密西根神經病變量表」來評估患者周邊神經病變症狀及足部檢測，「神經病變性疼痛量表」測量患者神經性疼痛情形、「醫療成果指標睡眠品質量表」來測量患者睡眠品質、「症狀嚴重度量表」，評估透析患者常見症狀困擾、「醫院焦慮及憂鬱量表」之憂鬱次量表評估患者憂鬱情形、以及「基本資料表」收集個案相關臨床資料，於97年4月至97年10月共收腹膜透析及血液透析患者162位。研究結果顯示有48位 (29.6％) 患者有周邊神經病變，其中以麻麻症狀發生率最高有64.6％，其次是刺痛感覺 (37.5％)，有41.7％覺得症狀在夜晚更嚴重。48位中有19位患者 (39.5％) 有神經病變性疼痛情形，以疼痛造成不愉快、尖銳刺痛為最常見的疼痛特質。血液透析患者周邊神經病變嚴重度得分顯著高於腹膜透析患者 (p=.03)，特別是透析量 (Kt/V)小於1.2者周邊神經病變較嚴重 (p=.003)，而年齡 (p＜.001)、鉀離子 (p=.003)與周邊神經病變有顯著相關，特別是年齡大於65歲者 (p＜.001)、鉀離子濃度超過4.3 mmole/L (p=.001)者周邊神經病變較嚴重。而患者的周邊神經病變 (p＜.01) 及神經病變性疼痛 (p＜.05) 與睡眠品質均有顯著正相關，且研究結果顯示有周邊神經病變合併神經病變性疼痛的患者 (11.7％)，睡眠品質是最差的。本研究有助於臨床護理人員對於透析患者周邊神經病變症狀有更深入的瞭解，並提供將來臨床照護及研究上的一個參考依據。

Among dialysis patients, one of the most common neuropathy is peripheral neuropathy, charactered by symptoms of sensori-motor polyneuropathy. The purposes of this crossectional, correlational study were to identify (1) the symptoms and severity of peripheral neuropathy in dialysis patients, and (2) the correlation between peripheral neuropathy with or without peripheral neuropathic pain versus quality of sleep. Eligible patients (who receive dialysis therapy more than 3 months) were recruited from a medical center in Taipei. Data were collected by Michigan Neuropathy Screening Instrument (MNSI), Neuropathic Pain Scale (NPS), Medical Outcome Study Sleep Scale (MOS-Sleep Scale), Symptom Severity Scale (SSS), and Hospital Depression Subscale (HDS). A total of 162 dialysis patients were studied. The results indicated that 48 patients (30％) with a clinical MNSI score≧2 had peripheral neuropathy. The most common symptom was numbness (64.6％), followed by worse at night (41.7％) and prickling (37.5％). Of 48 patients, 19 had peripheral neuropathic pain, charactered by unpleasant feeling and sharp pain (73.7％). The scores of peripheral neuropathy were more severe in hemodialysis patients than in peritoneal dialysis patients (p=.03), especially under adequacy dialysis (Kt/V＜1.2) with hemodialysis. Peripheral neuropathy was associated with age (p＜.001), and potassium (p=.003), especially age over 65 or potassium over 4.3 mmole/L. There were also significant relationship between peripheral neuropathy and quality of sleep (p＜.01); and between neuropathic pain and quality of sleep (p＜.05). Patients (11.7％) with peripheral neuropathy and neuropathic pain experienced the worst quality of sleep. In conclusion, our data provides more information about peripheral neuropathy perceived by dialysis patients for further clinical care and related studies.