研究主題 Researches

2019利用動脈壓與心率變異於血液透析過程中低血壓評估之可行性研究

台灣在106年的洗腎人口已突破8.5萬人,且以每年6%的幅度持續增加。血液透析治療過程中的併發症有低血壓、高血壓、不平衡症候群、胸痛等,其中低血壓的發生率高達25至50%,是最常見的併發症。反覆的低血壓容易造成血液停滯,導致患者心臟負擔過大,更有臨床證實低血壓的發生率與死亡率息息相關。血壓改變時會影響血流速和心率,但臨床量測血流速的方式是透過超音波量測,在透析治療中不易執行。心率的量測也常需額外的穿戴裝置,且容易受到晃動影響,這樣的方式也不適合有躁動症的患者。至今臨床僅能依靠護理人員每30至60分鐘的血壓量測或患者出現不適感才能發現。本研究提出一個可透過洗腎機連續量測的生理參數—動脈壓,探討該參數與心率作為透析期間評估低血壓的可行性。本研究將心率與動脈壓的記錄依照低血壓的風險程度進行資料分段,並建立評估低血壓的分類法則;在12位長期洗腎患者的臨床試驗結果中顯示,透過心率與動脈壓異常變異次數所建立的分類法則,用於低血壓風險的評估其準確度分別為85%和80%。進一步整合兩種參數的分類法則結果顯示,可提供90%準確度。本研究證實洗腎機提供的動脈壓訊號,可作為透析過程中低血壓的預測因子,若結合新率可提高準確度,相關結果可以提供護理人員對患者透析狀態的即時評估,藉此提高患者透析安全。

 

The number of end-stage renal disease patients in Taiwan had exceeded 85,000 in 2016, and is increasing at the rates of 6% each year. Complications of hemodialysis (HD) treatment include hypotension, hypertension, imbalance syndrome, chest pain, etc. In view of that the incidence of hypotension ranges from 25% to 50%, it is the most common complication during hemodialysis. Repeated hypotension causes blood stagnation and leads to excessive heart workload of patients. Moreover, clinical studies proposed that the incidence of hypotension had a high correlation with the rate of mortality. Heart rate (HR) and blood flow are affected by blood pressure variability (BPV), but the clinical blood flow rate is usually measured by ultrasound technology that is not easy to perform in HD treatment. HR measurement also requires the patients during hemodialysis to wear additional devices and is easily affected by patients’ movement. Furthermore, some HD patients developed restlessness, so HR measurement was less suitable for HD patients. Thence, in clinical practice, it could only rely on the BP measurement by the nursing staff every 30 to 60 minutes or the patient's discomfort complaint to detect the patient's hypotension. This study focused on the arterial pressure (AP), a physiological parameter which could be measured continuously through a dialysis machine, and discussed the feasibility of AP and HR as the evaluation for hypotension during hemodialysis. In this study, the records of HR and AP were segmented according to 3 risks of hypotension, and the rule-based evaluation for hypotension was established. The clinical trial results of 12 HD patients show that the number of abnormal HRV (ANHRV) and APV (ANAPV) could evaluate the risk of hypotension, with an accuracy of 85% and 80%, respectively. Further, it was proposed a rule-based method for two parameters. The result shows that using two parameters could provide the 90% accuracy to the evaluation of hypotension. The results indicated that AP and HR from the dialysis machine could be a predictor for hypotension during hemodialysis to provide an immediate aid of evaluation for the nursing staff to enhance the safety of hemodialysis.

 

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