照光療法是否能緩解透析病患之尿毒性搔癢症Phototherapy can relieve uremia pruritus in dialysis patients?

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2020-05-27 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

裘苕莙* 田久芸 陳美珠

實證知識類別

A 類:實證健康照護綜整

PICO

治療/預防性問題

治療/介入措施

腎臟與高血壓 Nephrology and Hypertension

科別

  • 護理領導 Nursing Leadership
  • 進階實務 Advanced Practice
  • 腎臟及泌尿護理 Renal and Urology Nursing

中文關鍵詞

透析、尿毒性搔癢症、照光療法

英文關鍵詞

dialysis uremic pruritus phototherapy

機構名稱

臺北榮民總醫院

申請單位

護理部

中文摘要

形成臨床提問:
尿毒性搔癢症一直是透析病患的夢靨,病患長期深受搔癢困擾,不僅影響社交活動,並且影響生活品質。目前對於尿毒性搔癢的治療大部分以凡士林、尿毒軟膏等潤濕劑或保濕劑使用等,治療效果不佳,且無絕對有效的治療方式。本文目的為透過實證方式探討照光療法是否能緩解透析病患之尿毒性搔癢症,希望能做為此類病患實證照護參考的依據。
文獻搜尋的方法與分析:
以PICO及MeSH term建立關鍵字及同義字,依據布林邏輯原則,搜尋PubMed、CINAHL、Cochrane library、Wiley online library及Google Scholar,共搜尋出212篇,刪除重複文獻(n = 7),與研究主題不符(n = 199),並排除非以英文出版(n = 1)、非以照光治療為主要介入措施之系統性文獻回顧(n = 2)、類隨機對照試驗(n = 1)等文獻,再以手動搜尋(n = 2),最後納入4篇隨機對照試驗研究進行評析。
文獻的品質評讀:
選用2011年英國牛津實證醫學中心醫學文獻證據等級分類標準(Oxford Center for Evidence-Based Medicine)及2013年Critical Appraisal Skill Program(CASP)為工具,進行有效性、重要性及應用性之評析,4篇文獻研究目的均在探討透析病患接受照光療法後尿毒性搔癢症的緩解成效,收案對象均為尿毒性搔癢症的透析病人,於文獻評析結論可知照光療法可減低抗組織胺或類固醇藥物使用量,合併照光療法及藥物使用,對治療尿毒性搔癢症有較佳療效。
結論與建議:
綜整評析結果發現照光療法可以緩解透析病患尿毒性搔癢症,每週2~3次照光療法,在定期的監控追蹤下,對尿毒搔癢症是安全又有效的治療。

英文摘要

Ask an answerable question (PICO):
Skin pruritus is an inevitable nightmare for many uremic patients. For long-term sufferers, the itching not only affects social activities, but also the quality of life. At present, most of the treatment for uremic pruritus is using wetting agents or moisturizers such as petroleum jelly, ointment, etc. The treatment effect is poor, and there is no absolutely effective treatment. The purpose of this article is to explore through empirical methods whether phototherapy can alleviate uremic pruritus in dialysis patients. The results can be served as a reference for empirical care for such patients.
The Method and Analysis of Literature Review:
Create keywords and synonyms with PICO and MeSH term, and search PubMed, CINAHL, Cochrane library, Wiley online library, and Google Scholar according to Bollinger’s logic principles. A total of 212 articles were searched. Duplicate documents (n = 7) and inconsistent research topics (n = 199) were deleted. We also exclude non-English publication (n = 1), systemic literature review that does not use phototherapy as the main interventional measure (n = 2), quasi-randomized controlled trials (n = 1). We also add manually search (n = 2), and finally included 4 randomized controlled trials for critical appraisal.
Critical Appraisal:
The 2011 Oxford Center for Evidence-Based Medicine (Oxford Center for Evidence-Based Medicine) and the 2013 Critical Appraisal Skill Program (CASP) were selected as tools to evaluate the validity, importance, and practicability. The purpose of the four literature studies is to discuss the effect of dialysis patients on the relief of uremic pruritus after receiving phototherapy. The subjects involved are dialysis patients with uremic pruritus. The review and analysis of the four references concluded that phototherapy can reduce the usage amount of antihistamine or steroid drugs, combined with phototherapy and drug use, it has a better effect on the treatment of uremic pruritus.
Conclusions and Recommendations:
A comprehensive review found that phototherapy can alleviate uremic pruritus in dialysis patients. Phototherapy 2~3 times a week is a safe and effective treatment for uremic pruritus under regular surveillance.