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研究生:陳宗瀛
研究生(外文):Chen, Chung-Yin
論文名稱:急性心肌梗塞患者之橈動脈脈波頻譜研究
論文名稱(外文):Spectral analysis of radial pulse wave in patients with acute myocardial infarction
指導教授:王唯工金鏗年金鏗年引用關係
指導教授(外文):Wang, Wei-KongChing, King-Nien
學位類別:博士
校院名稱:國立陽明大學
系所名稱:臨床醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:1994
畢業學年度:82
語文別:中文
中文關鍵詞:醫學心肌梗塞橈動脈
外文關鍵詞:MEDICINE
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研究背景。根據我的指導老師王唯工教授觀察液體動態模型的運作及結果,(按:楊順聰老師在小白鼠尾動脈所作的乃研究提供了此一液體動態模型確定的動物實驗證據 ),提出一個理論:主動脈與相聯接的內臟器官之間可以形成相互共振。因此,理論上來看該系統與心臟其實組成一個完整的共振迴路。我們十分想知道:這種理論與實際運作功能是否可在臨床領域中證實?
初研究理念。本研究構思實來自於楊順聰老師的動物實驗結果。在他的動物實驗中,楊老師發現即夾即放左側腎動脈或上腸繫膜動脈會改變小白鼠尾動脈脈波的頻譜分析。因此,我們即思考在臨床上有那一種疾病或疾病狀態可能短暫的改變與主動脈相連的內臟器官的血管阻力(或阻抗)與血 流。當然這部分血管阻力或血流的變化必須可用某一檢驗 室方法來偵測得知。然後,我們期待就像在楊老師的動物 實驗一樣,某特定內臟之血管阻力或血流量的改變,會反映 在患者橈動脈脈波的頻譜分析(藉離敬傅立葉轉換之助)。
研究方法。根據研究理念,我們分成兩階段來進行該研究。首先,我們藉用標記I-131的iodo-ortho-hippurate 靜脈注射而在準44分鐘後自另一處抽血來測定有效性腎 血漿流量的核子醫學檢查來研究急性但無併發症 (Killip 第一型)心肌梗塞後有效性腎血漿流量的變化。再系列性測定心房利鈉激素或鏈胜以研究有效性腎血漿流量的變化是否與此相關。其次,我們每日記錄急性但無併發症急性。、肌梗塞患者右手橈動脈脈波,並藉用離散傅立葉轉換來分析是項動脈脈波之能量頻譜。這項動脈脈波能量頻譜分析更包括了三組無心肌梗塞患者作為參考基準。
研究結果。從第一部分的研究過程,我們有下列三項結果:
(1)在12例無心肌梗塞而僅住院接受冠狀動脈攝影檢查之冠心症患者,我們證實藉用I-131 iodo-ortho-hippurate測定有效性腎血漿流量之再生性良好,係一有效且方便的檢測方法。
(2)急性但無合併症之心肌梗塞發生後,患者都表現有短暫性有效性腎血漿流量增力加的現象;
(3)上述這種短暫性有效性腎血漿流量增高,至少有一部份的原因是因於急性心肌梗塞後心房利鈉激素或鏈胜升高的結果。
而在第二部分的研究中,我們有了以下的觀察結果:
(1)急性但無併發症之心肌梗塞後之當時,患者橈動脈脈波能量頻譜之諧頻CO會暫時降低(雖然不具統計學有意義的降低 ),而逐漸隨心肌梗塞的恢復而回復與無心肌梗塞患者相匹配的程度;
(2)在急性但無併發症之心肌梗塞後之當時,橈動脈波能量頻譜中諧頻C2與C3之百分比程度(Percentag intntensity of co)會呈現短暫性的降低;而後隨急性心肌梗塞的逐日恢復而回復其與無心肌梗塞患者相匹配的水準;
(3)急性心肌梗塞後,橈動脈脈波能量頻譜中諧頻C2與C3之百分比程度之短暫性降低與急性心肌梗塞後有效性腎血漿流量之增加呈現有統計學意義的反向相關。
結論。Selwyn指出,局部組織或器官的血流量實在是判定該組織或器官功能正常或疾病的重要指標。他曾藉正子閃爍電腦斷層掃描與標記C-12之人類自蛋白來偵測各重要器官,如:腦.肝.心...等局部臟器血流。本研究可能是第一次提供數據證實急性但無併發症心肌梗塞後有效性腎血漿流量會有短暫性升高而後逐漸降低的變化,可能是局部血管阻力減低的結果。而心房利鈉鍊胜之短暫性升高可能是有效性腎血漿流量升高的主要因素或眾多因素之一。而有效性腎血漿流量短暫性升高可能反映在動脈脈波能量頻譜中短暫性降低其百分比強度之諧頻c2與c3。這個觀察事實上是首次有臨床數據顯示內臟血管阻力或血流的改變可由往傅立葉轉換得到之動脈脈波能量頻譜分析中偵知。而這項觀察結果不但提供王老師之液體動態模型有臨床證據,並支持王老師的理論:與主動脈相連的臟器可與主動脈形成共振,而全一系統實乃一個共振迴路。臨床應用。本研究之臨床實用性有二:
(1)檢視動脈脈波能量頻譜分析中之諧頻C2與C3百分比強度,可作為監視急性但無併發症心肌梗塞病程恢復順利與否之指標。
(2)急性但無併發症心肌梗塞發生後,腎血管叢對於交感神經興奮度增加的反應不同;而此項相異的反應應與心肌梗塞後心房利鈉激素之增加相關。
Background. According to Wang et al''s observation from the operation of their dynamic fluid model, which has been further demonstrated by the Young et al''s animal study, that aorta and closely linked internal organ may cause coupled oscillation and theoretically this integrated system together with the heart is actually acting physiologically as a resonance circuit. We are wondering whether this theoretical model and its function is really existing and can be demonstrated clinically.
Rational.The idea of the study is actually from Young et al''s animal observation that briefly clamping the renal artery or the supramesentery artery might change the power spectrum of tail arterial pulse of rat. Therefore, we have to seek a disease condition or state which may alter the vascular resistance or plasma flow of one internal organ which linked to aorta, and certainly this alteration should be able to measure with existing laboratory technique. Then, we hope we are able to see this alteration of vascular resistance or plasma flow of this specific internal organ in the power spectrum of patient''s radial pulse derived from discrete Fourier''s transformation.
Method.The whole study is now dividing into two steps. Firstly, we are using intravenous injection of 1-131-iodo-ortho-hippurate to measure the effective renal plasma flow immediately after and one week after acute but uncomplicated myocardial infarction in 17 patients. Serial measurement ofatrinatriuretic peptide of these patients was also carried out to demonstrate whether or not it is attributing to the alteration of effective renal plasma flow after myocardial infarction. Secondly, we recorded the radial pulse of all these patients with acute but uncomplicated myocardial infarction non-invasively everyday for ten days , and studied the power spectrum of pulsewaves derived by discrete Fourier''s transformation. Three more groups of patients who are not having myocardial infarction were as control for comparison.
Results. In the first part of the clinical study we demonstrated followings:
(1) the good reproducibility of effective renal plasma flow by using I-131-iodo-ortho-hippurate isotopes in 12 control patients, and proved this technique is useful and effective;
(2) the initial elevation of effective renal plasma flow immediately after acute but uncomplicated myocardial infarction, reduced a week later; and
(3) the early elevation of atrinatriuretic peptide after myocardial infarction may, at least partly, contribute to the initial elevation of effective renal plasma flow.
In the second part of this clinical study we have the following observations:
(1) immediately after acute but uncomplicated myocardial infarction, the patient may show lower intensity of harmonics CO of the power spectrum of radial pulse, although statistically insignificant, and the intensity may gradually return to the level compatible to those patients who did not have acute myocardial infarction;
(2) immediately after myocardial infarction, both the harmonic C2 and C3 show lower (statistically significant) in percentage intensity of the average intensity of radial pulse, the CO, and gradually increased along with the recovery of the disease in a few days;
(3) the initial drop or reduction of the percentage intensity of both harmonic C2 and C3 of the average intensity of radial pulse, the CO, reversely correlates with the initial elevation of the effective renal plasma flow with statistically significant p value;
Conclusion. As Selwyn pointed out in his study of regional blood flow distribution after acute myocardial infarction, using ll-C labeled human albumin microsphere and PET scanning technique, that blood flow in regional tissue is a critical determinant of function in health and disease. We are probably the first to demonstrate that the effective renal plasma flow does transiently increase after acute but uncornplicated myocardial infarction (most likely due to the reduction of regional vascular resistance). The transient elevation of atrinatriuretic peptide may play an important role for this transient increase of effective renal plasma flow but does not alter renal function, urine and plasma electrolytes or the urine amount. And this transient increase of effective renal plasma flow can reflect on to the power spectrum --reduction of the percentage intensity of both harmonic C2 and C3 -- of radial pulse, using discrete Fourier''s transformation. These clinical observations provide further related evidence in support of the finding of dynamic fluid model and Wang''s theory that aorta and closely organs may cause coupled oscillation, and the structure is equivalent to a resonance circuit.
Clinical Implication.The clinical implication of this clinical study at this moment can be twofold:
(1) non-invasive recording of radial pulse may be useful to monitor the recovery of acute but uncomplicated myocardial infarction by checking the percentage intensity of harmonic C2 and C3;
(2) vascular bed of kidneys may respond differently to the enhanced sympathetic activity after acute myocardial infarction; and this unusual response may be related to the release of atrinatriuretic peptides.
封面
中文摘要
英文摘要
第一章緒論
第二章血管循環系統與共振理論--血液分配與灌注
第三章傅立葉轉換與動脈壓脈波頻譜研究之文獻回顧
第四章急性心肌梗塞與有效性腎血漿流量研究
第五章急性心肌梗塞患者橈動脈脈波頻譜研究
第六章結論
參考文獻
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