鬱血性心衰竭患者寸口脈波圖及心率變異分析;
A STUDY OF RADIAL SPHYGMOGRAM AND HEART RATE VARIATION IN PATIENTS WITH CONGESTIVE HEARAT FAILURE

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Title:	鬱血性心衰竭患者寸口脈波圖及心率變異分析;A STUDY OF RADIAL SPHYGMOGRAM AND HEART RATE VARIATION IN PATIENTS WITH CONGESTIVE HEARAT FAILURE
Authors:	黃漢倫;Han-luen Huang
Contributors:	中國醫藥大學：中西醫結合研究所碩士班
Keywords:	中西藥併用;病例追蹤研究;行病學;SPSS;Concurrent use of TCM-Western medicine;Follow-up study;Epidemiology;SPSS
Date:	2007-06-29
Issue Date:	2009-08-06 11:02:45 (UTC+8)
Abstract:	(一)目的：傳統中醫認為寸口六部分候臟腑，而左寸候心。鬱血性心臟衰竭患者左寸脈象是否與健康人不同，值得研究。 (二)重要性：本試驗探討心臟臟衰竭患者寸口脈波圖之變化及心律變異分析，並評估其臨床症狀之嚴重程度，是否與左寸脈波圖各項參數相關。 (三)材料與方法：本試驗計劃由新竹國泰醫院內科病房及門診中招募30位罹患鬱血性心臟衰竭的患者為實驗組。另由內科病房及門診中招募19位年紀性別相當之志願者為對照組。鬱血性心臟衰竭患者之篩選，乃依據Framingham Heart Study的診斷標準，必須符合兩項主要條件，或是一項主要條件加上兩項次要條件。依紐約心臟學會(New York Heart Association)之分類標準，將鬱血性心臟衰竭症狀嚴重程度分為四級，以評估心臟功能。兩組先進行心臟超音波檢查後，再使用台灣科學地非侵入式血壓測量儀量取兩側寸口脈壓力波形及心率變異分析。 (四)主要成果：本研究結果在心臟超音波檢查方面顯示左心室收縮功能、舒張功能、左心室容積、下腔靜脈寬度、右心室收縮壓方面在兩組有顯著差異。心率變異分析顯示實驗組在心率變異、總功率、低頻、高頻、極低頻及心跳速率變異數皆明顯較對照組低下。在寸口六部脈波圖時域分析方面，顯示實驗組與對照組六部脈波圖相比皆有差異，而兩組在左寸部差異又最多。這表示鬱血性心臟衰竭患者與健康者相比，在左寸脈象上的確有較多特殊的變化。左寸候心之說，似乎有其可能性，但究竟是否適用於其它心臟疾病，尚待更多研究來證實。 Traditional Chinese medicine dictates that the bilateral Tsun, Guan, Chi of radial pulse areas would be the reflection of some specific internal organs. The left tsun pulse area is associated with condition and activity of heart. It is interesting to understand whether the pulse characteristics at the left Tsun pulse area are truly different from patients with heart disease and that of the normal population. This study analyzes the radial sphygmography whether the heart failure symptoms are associated with specific variables in the left radial sphygmography and heart rate variability. Thirty patients with congestive heart failure (CHF) are selected from the out patient department and ward of Internal Medicine, then categorized into four levels according to the severity of clinical symptoms. The control group is comprised of niteen normal populations of a similar mixture of age and gender, also selected from the out patient department and ward of Internal Medicine. Patients with congestive heart failure were screened via our ward as Framingham Heart Study did, and then categorized into four levels according to the severity of clinical symptoms. Both groups received echocardiogram first then, ANSWatch Model TS 0411 was used to measure both the heart rate variability and the waveform values of bilateral radial Tsun, Guan, Chi pulse areas . Echocardiogram results indicate significant difference in left ventricular systolic function，left ventricular diastolic function，left ventricular volumn，inferior vena cava diameter and right ventricular systolic pressure. Heart rate variability analysis result found significant decrease in heart rate variability，total power，low frequency，high frequency，very low frequency and variance in congestive heart failure group. Radial sphygmography results indicate that there are more different value in left Tsun pulse area between the control group and the experimental group. Results of our study suggest that it is likely that the pulsation at the left Tsun pulse area is associated with the conditions of the heart but further studies may be required to determine the practical implication of this model.
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