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接受血液透析之慢性腎衰竭患者之心率變異性分析

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接受血液透析之慢性腎衰竭患者之心率變異性分析

The Analysis of Heart Rate Variability of Chronic Renal Failure Patients Receiving Hemodialysisb

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。

英文摘要

Purpose This study is aimed to explore the relationship between heart rate variability (HRV) parameters and 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 hemodialysis 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 deviation of all RR intervals. The short-term frequency domain HRV parameters are computed using fast Fourier transform (FFT). Five frequency domain and two time domain parameters of HRV

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are calculated: (1) LF: 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/HF: 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 electrolyte concentrations before and after hemodialysis. Two-sample t-test was used to compare pre- and

postdialysis 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. Reduced phosphate level decreases sympathetic activity after hemodialysis. Increased calcium concentration is result in vagal modulation reduction. Decreased sympathovagal interaction is due to potassium level reduction. 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.

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