心臟衰竭患者左心室功能與脈波圖之相關性

張恒鴻
長庚紀念醫
心臟衰竭的病人，其日常活動功能和左心室功能密切相關。本計劃以心臟超音波測量左心室射出率(Left ventricular ejection fraction)來評估左心室收縮功能，並將病人以心臟功能分級(NYHA Functional Class)加以分類，來代表其臨床症狀之嚴重程度。中醫自古就有以脈診分析疾病的方法，因此本計劃採用非侵入性的方式，使用汪氏脈波儀(Wang’s sphygmometer)在遠端的橈動脈上經由體表來記錄壓力波。此外，中醫將心臟衰竭的病患依臨床症狀的表現診斷為幾種不同的證型，而各個證型會有不同的脈象表現。因此，本計劃希望藉由脈波圖來分析(1)橈動脈壓力波型與心臟衰竭患者之左心室射出率(Ejection Fraction)之相關性；(2)橈動脈壓力波型與心臟功能分級(NYHA Functional Class)之相關性；(3)心臟衰竭患者中醫診斷證型和左心室功能之相關性。
本計劃參考Framingham Heart Study對鬱血性心衰竭(Congestive Heart Failure)的診斷標準來篩選病患，並排除患有週邊動脈阻塞性疾病以及生命徵象(體溫、心搏、呼吸、血壓)不穩定者。病患將依序接受(1)生命徵象的測量；(2)依紐約心臟學會之分級將患者分為四類；(3)進行完整的心臟超音波檢查以評估病患之左心室功能；(4)經由中醫診斷區分病患之主要證型；(5)使用汪氏脈波儀量取病患兩側寸脈壓力波型，並加以分析。
關鍵字：心臟衰竭,脈波圖,左心室功能,中醫

The Association between Left Ventricular Function and Sphygmogram of Heart Failure Patients

Hen-Hong Chang
Chang-Gung Memirial Hospital
The daily activity function is closely associated with the left ventricle function in patients with congestive heart failure (CHF). We assess the left ventricle contractibility by left ventricular ejection function with cardiac echo. Their severity are classified according to” NYHA Functional Class”. Also we record radial artery pulse pressure by Wang’s sphygmometer non-invasively to imitate that traditional Chinese medical (TCM) doctors did. According to the classic documents, different patterns present various pulses, we also evaluate their association.CHF patients are screened via our ward as Framingham Heart Study did, those who suffered from unstable vital signs or with peripheral arterial occlusive diseases are excluded. The others are evaluated by their clinical severity, left ventricular function, patterns in TCM and bilateral sphygmograph.
關鍵字：Heart Failure,Sphygmogram,Left Ventricular,Traditional Chinese Medicine