接受血液透析治療之尿毒患者的腕道症之研究

中山醫學大學機構典藏 CSMUIR > 醫學院 > 醫學研究所 > 博碩士論文 > Item 310902500/1102

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题名:	接受血液透析治療之尿毒患者的腕道症之研究 A Study on Carpal Tunnel Syndrome in Uremia Patients Receiving Hemodialysis
作者:	呂聰明 Leu, Tsong-Ming
贡献者:	中山醫學大學：醫學研究所;林中生；張楊全
关键词:	腕隧道症;多發性神經病變;尿毒症;血液透析;糖尿病;電氣學診斷 carpal tunnel syndrome;polyneuropathy;uremia;hemodialysis;diabetes;electrodiagnosis
日期:	1995
上传时间:	2010-04-02T03:19:57Z (UTC)
摘要:	以中山醫學院附設醫院接受血液透析的尿毒患者共 62 人，男性 32 人，女性 30 人，平均年齡 58.4 歲，平均接受血液透析治療時間為 4.37 年，以問卷、臨床檢查、抽血及電氣診斷檢查等，來評估洗腎患者的腕隧道症或多發性神經病變之發生率，洗腎時間或β -2 微小球蛋白 (microglobulin) 與腕隧道症之關係，洗腎病人做動靜脈分流對腕隧道症發生的影響。在本研究中，並且以正常者 45 人，男性 22 人，女性 23 人，平均年齡 50.7 歲，為控制組。結果顯示腕隧道症之發生率為 56 手／ 124 手 ( ＝ 45.2 ％ ) 比一般報告偏高，多發性神經病變之發生率為 35 人／62 人 ( ＝ 56.5 ％ ) 。以 Polymethylmethacrylate 為透析膜洗腎者，較使用 cuprophan membrane 者，有較低的腕隧道症發生率。血液中β -2 microglobulin 濃度或洗腎時間，與腕隧道症之發生，皆無相關性。動靜脈分流至腕關節距離與腕隧道症發生率，也無相關性。以電氣診斷檢查，發現洗腎患者神經傳導速度比控制組慢，而神經傳導潛時則較控制組延長，但洗腎患者的做血管分流與未做血管分流的手，則沒有差別。糖尿病患和非糖尿病的尿毒患者，與控制組比較神經傳導速度、神經傳導潛時及神經傳導振幅，發現非糖尿病的尿毒患者比控制組差，糖尿病患又比非糖尿病的尿毒患者更差，但是糖尿病患與非糖尿病的尿毒患者，其做或未做血管分流，與臨床症狀之有無並無相關性，但與腕隧道症之發生有相關性，因此血液透析的尿毒患者做動靜脈分流並不會影響到神經傳導速度、神經傳導潛時及神經傳導振幅，糖尿病與尿毒病患皆可造成多發性神經病變，而在尿毒患者中，糖尿病患比非糖尿病患有較高的腕隧道症發生率，且電氣診斷檢查為最理想且最敏感的腕隧道症診斷方法。 A study to investigate the relationships between hemodialysis and carpaltunnel syndrome (CTS) or polyneuropathy was performed on 62 uremic patientsin Chung Shan Medical and Dental College Hospital. There were 32 males and 30 females, with a mean age of 58.4 years and a mean hemodialysis period of 4.37years. All the patients received questionnaire interview, medical review,physical check-up, and neurological examinations. The site of artificial arteriovenous (AV) shunt in the forearm was carefully recorded. The blood levelof β2 microglobulin was determined. Motor and sensory nerve conduction studieson the bilateral median and ulnar nerves were carried out. For an electrodiagnostic comparison, 22 male and 23 female normal subjects were enrolled as a control group. The prevalence of CTS in the uremic patients was 45.2 ％(56 hands ／124 hands) which was higher than those reported in the literature.The occurrence rate of CTS was lower in the uremic patients receiving hemodialysis with polymethylmethacrylate than those with cuprophanmembrane hemodialysis. Both the blood β2 microglobulin level and dialysisperiod were not influentialfactors on the occrrence rate of CTS, neither didthe distance between AV shunt and wrist joint. The prevalence of polyneuropathywas 56.5 ％ which was lower than those reported in the literature. In nerveconduction studies, uremic patients had slower nerve conduction velocities,(NCVs), longer latencies and lower amplitudes of evoked action potentialsthan the normal subjects. Between the shunting and non-shunting hands, therewere nosignificant differences of NCVs, latencies, or amplitudes of actionpotentials. All of these electrodiagnostic parameters were more severelyaffected in the diabetic than the non-diabetic uremic patients. Theseelectrodiagnostic differences had a good accordance with the clinicalfindings of higher incidence of CTS or polyneuropathy in the diabetic thanin the non-diabetic patients. In conclusion, uremic patients with hemodialysishad a high incidence of CTS. The contributing factors were dialysis materials,and coexisted diabetes. Nerve conduction studies provide a sensitive method toevaluate CTS in theuremic patients.
URI:	http://140.128.138.153:8080/handle/310902500/1102
显示于类别:	[醫學研究所] 博碩士論文

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