腎臟衰竭病患血液透析前後血壓波分析研究

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

黃中瑀1鄭仲益2鄭喬之3陳紀縈4郭育誠3,5,6,*

1臺北市立萬芳醫院傳統醫學科，台北，台灣

2臺北市立萬芳醫院腎臟科，台北，台灣

3當代漢醫苑中醫診所，台北，台灣

4臺北醫學大學醫學系，台北，台灣

5臺北醫學大學，台北，台灣

6中國醫藥大學，台中，台灣

探討腎臟衰竭病人血液透析前後血壓諧波的改變情形，利用血壓諧波分析方法討論血壓諧波是否能做為血液透析過程中評估風險與預警的指標。方法：在醫學倫理委員會的許可下，隨機在台北醫學大學萬芳醫院血液透析室招募四十六位志願的末期腎病患者參加本試驗。受試者於血液透析前後各接受一次5分鐘的血壓波量測（使用脈診血壓計－帝寶電子血壓計HL158HA），量測結果的分析，將以血壓諧波作為主要之評估依據。其他生理測量數據如收縮壓、舒張壓、心律、體重將作為次要之評估依據進行分析。結果：血液透析的病患在透析前後收縮壓、舒張壓、心律沒有顯著變化。體重因脫水減少2.5公斤（p<0.05），脈搏壓（pulse pressure）顯著下降（前後減少2.6%，p<0.05），但脈搏壓變異係數沒有顯著差異。血壓第三諧波（harmonic of pulse pressure）顯著上升（前後增加14.8%，p<0.05），在第四血壓諧波變異係數也顯著上升（前後增加24.7%，p<0.05）。討論：透析過程中循環系統的負擔藉由第四諧波變異係數的上升來表現，透過第四諧波變異係數的監控與預警，可以避免血液透析病患潛在的心血管系統風險。血壓諧波的即時監控將是病患經濟實惠又有效的解決方案。

【關鍵詞】末期腎病 ； 血液透析 ； 水和狀態 ； 血壓諧波分析 ； 諧波變異係數料

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