洗腎 通血管 COVID-19疫情

在COVID-19疫情下，洗腎患者通血管也增加了困難度，早上9點前患者要先至急診做PCR，大約中午過後，確認無感染，下午才可以被叫入導管室通瘻管，所以通完能離開醫院已經傍晚了，一天就過去了... (玉PT世)

 

洗腎患者C肝轉陽的故事、2025消除C肝

一位原來沒有C型肝炎的腎友，到醫院開刀和輸血後，回來我們常態抽血發現肝指數上升，接著追蹤，發現弱C肝陽性，事情大條了...

趕緊轉診至醫院的肝膽科門診，抽血測HCV RNA，2週後看報告，果然是C肝轉陽，醫院依規定通報疾管署，結果疾管署就來電說：第一「為什麼我們的病人C肝轉陽，是由醫院通報，而不是我們？」第二「要我們說明洗腎室內的感控措施」第三「要我們院內每個腎友每個月測ANTI-HCV AB，連續三個月」

真是無妄之災啊！病人到醫院治療後，C肝轉陽，結果疾管署要來檢查洗腎室？只因為他是這裡的腎友？第一，當然我們院內感控依規定處理，是沒有什麼好擔心的。第二，為了求慎重，所以我們把再次確認C肝的任務交給醫院方，所以確診報告在醫院，當然是由醫院通報，而不是我們規避通報C肝。

只是最後每個腎友每個月加測ANTI-HCV AB 3個月，這筆不能申報健保費用，數萬元的費用，要找誰要啊？腎友到醫院得了C肝回來，洗腎室人仰馬翻，賠人夫人又折兵。

後記：

這位腎友在肝膽科門診，服用了3個月的抗C肝病毒藥物，定期追蹤，預期應該也能達成消除C肝的目標了。以下是政府目前的2025消除C肝政策。

(雄PT武)

COVID-19、AZ 疫苗、洗腎、血液透析

 響應國家建議幫洗腎患者打疫苗

本院施打率

時間： 2021/06/15

標題： 【院所透析病人接種COVID-19疫苗實施方案】

https://www.tsn.org.tw/UI/G/G00101.aspx?gid=G8D92FF46E4D4252

台灣腎臟醫學會 理事長   黃尚志

2021-06-08, 2021-06-12

以下為台灣腎臟醫學會的統計

https://www.facebook.com/photo/?fbid=4848706011813006&set=pcb.4848696145147326

斷食療法和體重、168、NEJM、JAMA

Effects of Intermittent Fasting on Health, Aging, and Disease

N Engl J Med 2019; 381:2541-2551 DOI: 10.1056/NEJMra1905136

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September 28, 2020

Effects of Time-Restricted Eating on Weight Loss and Other Metabolic Parameters in Women and Men With Overweight and Obesity

The TREAT Randomized Clinical Trial

JAMA Intern Med. 2020;180(11):1491-1499. doi:10.1001/jamainternmed.2020.4153

Finally, the DXA analysis of lean mass did not factor in muscle hydration, so it is possible that changes
in hydration could confound the lean mass calculations. To help control for this, participants fasted for more than 12 hours and voided their bladder prior to DXA scans. The change in lean mass in the TRE group was much greater than the loss of body water, so it is unlikely that differences in muscle hydration would account for all of the lean mass loss.

PS1: 非脂肪組織：瘦體組織（Lean Body Mass，LBM）

PS2: 四肢骨骼肌肉質量(appendicular skeletal muscle mass,ASM)

差點被中藥包紮壓壞的洗腎瘻管

一位幾週前跌倒洗腎患者，原本左手包上困定架，不需要開刀。2天前骨科回診說定型了、不用包了（應該就是好了），但是患者覺得骨科沒有開刀、沒有開藥吃，他覺得還會痛或是腫？說要再去找中醫看。

結果今天來時，洗腎瘻管幾乎沒有聲音，護理師將中醫纏的繃帶鬆開，請患者手動一動，才稍微恢復了瘻管的流量，打上針，幸好還可以洗，真是萬幸！

這位中醫不知道洗腎瘻管不能壓迫或是纏繞嗎？

善良的病人說：沒關係，若是瘻管塞住或是壞掉，再去通或是開刀就好了...

洗腎 通血管 二難的開刀選擇

 一位年輕、剛開始洗腎患者，少年時有腦傷留下右手無力後遺症，慣用手是左手，因此自體瘻管就開在右手了。這真的是兩難，右手是無法配合握力來訓練瘻管的狀況，但是左手是他的慣用手也不是開瘻管的首選啊！（倫pt瑋）

結論：還是開在右手，瘻管血流不夠時怎麼辦？只好通血管了

穀類食物和心血管疾病死亡率關係

Associations of cereal grains intake with cardiovascular disease and mortality across 21 countries in Prospective Urban and Rural Epidemiology study: prospective cohort study

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.m4948 (Published 03 February 2021)

結論：
High intake of refined grains was associated with higher risk of mortality and major cardiovascular
disease events. Globally, lower consumption of refined grains should be considered.

No significant associations were found between intakes of whole grains or white rice and health outcomes.

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看起來要少食低纖類穀物才能減少心血管疾病，但是白米和全穀類相比則無差異。

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We defined refined grains as wheat grain products or flours that have been modified to remove the bran (麥麩) (the aleurone layer) and germ and therefore have a low fibre content. Products in this category are made with refined (white) flour, including white bread, pasta/noodles, breakfast cereals, crackers, and bakery products/desserts containing refined grains. For bakery products and desserts, we counted only the proportion of refined grains. Ready to eat breakfast made from corn was also included in this group.

The whole grains group contained two types of grains. The first was whole grain flours such as those
made from wheat, rye, triticale, oats, barley, maize, finger and pearl millet, sorghum, or buckwheat.