肾脏衰竭病患血液透析前後血压波分析研究

Analysis of blood pressure wave before and after hemodialysis in patients with renal failure

黄中瑀1郑仲益2郑乔之3陈纪萦4郭育诚3,5,6,*

1台北市立万芳医院传统医学科，台北，台湾

2台北市立万芳医院肾脏科，台北，台湾

3当代汉医苑中医诊所，台北，台湾

4台北医学大学医学系，台北，台湾

5台北医学大学，台北，台湾

6中国医药大学，台中，台湾

探讨肾脏衰竭病人血液透析前後血压谐波的改变情形，利用血压谐波分析方法讨论血压谐波是否能做为血液透析过程中评估风险与预警的指标。方法：在医学伦理委员会的许可下，随机在台北医学大学万芳医院血液透析室招募四十六位志愿的末期肾病患者叁加本试验。受试者於血液透析前後各接受一次5分钟的血压波量测（使用脉诊血压计－帝宝电子血压计HL158HA），量测结果的分析，将以血压谐波作为主要之评估依据。其他生理测量数据如收缩压、舒张压、心律、体重将作为次要之评估依据进行分析。结果：血液透析的病患在透析前後收缩压、舒张压、心律没有显着变化。体重因脱水减少2.5公斤（p<0.05），脉搏压（pulse pressure）显着下降（前後减少2.6%，p<0.05），但脉搏压变异系数没有显着差异。血压第三谐波（harmonic of pulse pressure）显着上升（前後增加14.8%，p<0.05），在第四血压谐波变异系数也显着上升（前後增加24.7%，p<0.05）。讨论：透析过程中循环系统的负担藉由第四谐波变异系数的上升来表现，透过第四谐波变异系数的监控与预警，可以避免血液透析病患潜在的心血管系统风险。血压谐波的即时监控将是病患经济实惠又有效的解决方案。

【关键词】末期肾病 ； 血液透析 ； 水和状态 ； 血压谐波分析 ； 谐波变异系数料

Objective: To explore the changes of blood pressure harmonics in patients with renal failure before and after hemodialysis, and to discuss whether blood pressure harmonics can be used as indicators of risk assessment and early warning during hemodialysis using the method of blood pressure harmonic analysis. Methods: With the approval of the Medical Ethics Committee, 46 voluntary ESRD patients were randomly recruited in the hemodialysis room of WanFang Hospital of Taipei Medical University to participate in this trial. The subjects received a 5-minute blood pressure harmonic measurement before and after hemodialysis. Results: There were no significant changes in systolic blood pressure, diastolic blood pressure, and heart rate in hemodialysis patients before and after dialysis. Body weight was reduced by 2.5 kg due to dehydration(p<0.05)and there was a significant decrease in pulse pressure(-2.6%, p<0.05), but there was no significant difference in pulse pressure coefficient of variation. There was a significant increase in the third harmonic of pulse pressure(+14.8%, p<0.05), and the fourth harmonic coefficient of variation increased significantly(+24.7%, p<0.05). Discussion: The burden of the circulatory system during dialysis is represented by the increase of the fourth harmonic coefficient of variation. Through the monitoring and early warning of the fourth harmonic coefficient of variation, it can avoid potential cardiovascular system risks of hemodialysis patients. Immediate monitoring of blood pressure harmonics would be an economical and effective solution for patients.

【Keywords】end-stage renal disease (ESRD)； hemodialysis； hydration state； harmonic of pulse pressure； harmonic coefficient of variation