接受血液透析之慢性腎衰竭患者之心率變異性分析
中文摘要
心率異性分析 ( Heart Rate Variability, HRV ) 對評估心臟自主神經調節功能已被證實為 非侵入性且有效的工具。 慢性腎衰竭患者接受長期血液透析治療造成不可逆之自主神 經病變可由心律變異性降低來評估。
血液透析治療中體液電解質之改變亦會造成心律不整，尤其是鉀離子過高或過低皆會引 發心室型心律不整。
為了能即時得知心率之變化，本研究使用 5 分鐘心電圖做時域及頻域之分析，取得時域 及頻域之各項參數。為了找出電解質與自主神經系統之相關性，本研究就透析前後電解 質濃度與心律變異性參數比較並找出其相關性。
本研究包含 62 位 ( 男性 47 位，女性 15 位，平均年齡 24.08±7.71 歲 ) 親民工商專校及 亞東紀念醫院無心臟病史的人員為心率變異性參數之對照組。 26 位長期接受血液透析 治療的患者 ( 男性 13 位，女性 13 位，平均年齡 56.7±13.8 歲 ) 收集患者年齡，血液 透析前後 5 分鐘心電圖，鈉離子、鉀離子、鈣離子、磷酸根離子、氯離子的血中濃度。收集之心電圖用電腦程式處理後取得時域及頻域之各參數，並與電解質濃度做相關性之 統計分析。
研究結果顯示，血液透析前持續接受透析的時間長會使得 SDRR 、 LF 、 HF 增加，表 示長期且規則的血液透析治療會增加自主神經之活性。 血液透析後磷酸根離子濃度降 低會使交感神經活性降低。 鈣離子濃度增加會使副交感神經活性降低。 鉀離子濃度降 低則會影響到交感 - 迷走之交互作用。血液透析前後電解質及 LF/HF 比例有顯著之意義，其他心率變異性參數並無顯著之差異。
The Analysis of Heart Rate Variability of Chronic Renal Failure Patients Receiving Hemodialysisb
英文摘要
Purpose This study is aimed to explore the relationship between heart rate variability (HRV) parameters an d electrolyte concentrations in both pre- and post-dialysis.
Method 26 chronic renal failure patients (13 women, 13 men, 56.7±13.8 years) receiving maintenance hem odialysis therapy and 62 normal subjects (47 men ， 15 women ， 24.08±7.71 years) were included in this study. Patients were measured 5-minute ECG at rest. Calcium, phosphate, sodium, potassium, and chloride concentrations were collected before and after hemodialysis. ECGs were digitized by microcomputer. The next step was calculating the RR interval duration, then measuring average of RR intervals and standard de viation of all RR intervals. The short-term frequency domain HRV parameters are computed using fast Fou rier transform (FFT). Five frequency domain and two time domain parameters of HRV are calculated: (1) L F: power in LF (low-frequency), range (0.04~0.15Hz); (2) LF norm: LF power in normalized units; (3) HF:
power in HF (high-frequency), range (0.15~0.4 Hz); (4) HF norm: HF power in normalized units; (5) LF/H F: Ratio LF /HF; (6) MeanRR: average of RR intervals; (7) SDRR: standard deviation of all RR intervals.
Statistical Analysis Wilcoxon signed rank test was used to compare HRV parameters and electrolyte levels before and after hemodialysis. Linear regression was performed to correlate HRV parameters with electrol yte concentrations before and after hemodialysis. Two-sample t-test was used to compare pre- and postdial ysis HRV parameters with normal subjects. p<0.05 was considered significant.
Result The longer duration of hemodialysis may increase SDRR, LF, and HF before hemodialysis. There is no significant relationship between electrolyte concentrations and HRV parameters before hemodialysis. R educed phosphate level decreases sympathetic activity after hemodialysis. Increased calcium concentration is result in vagal modulation reduction. Decreased sympathovagal interaction is due to potassium level red uction. Calcium, phosphate, sodium, potassium, and chloride concentrations change significantly between before and after hemodialysis. There is no significant relationship on HRV parameters, except LF/HF ratio, before and after hemodialysis.
