心率變異數與APACHE II、III對重症病人中醫體質證型之研究-（心臟血管手術預後評估與中醫證型之關聯研究）

林國瑞
中國醫藥大學
中醫學將陰陽概念應用於病機、診斷和治療各方面。而中醫辨證學中所歸納的陰陽體質，其表現有臟腑、內分泌及各種在生理機能上的改變，這也造成中醫診斷上的客觀化有其困難，雖然已經有一些四診現代化儀器。目的：重症心臟病為現代健康的重大挑戰，我們研究重症心臟病手術治療後患者，運用心率變異數（HRV），疾病嚴重度指標APACHE( Acute Physiology, Age and Chronic Health Evaluation) II，全身性系統發炎時之細胞激素反應及多重器官衰竭指標，並和傳統的中醫證型結合與四診工具，結合臨床專家的經驗判斷，建立中醫診斷規範，冀使評估工具標準化。方法：經人體試驗委員會通過後，預計隨機選擇100個重症心臟病手術治療後住入加護病房患者，排除有腦部疾病、心律失常，不改變常規治療，進行此前瞻性的觀察實驗。病患評估其手術前、手術後12小時、手術後48小時及離開ICU時的全身性系統發炎反應之細胞激素反應及多重器官衰竭指標，APACHE II、III與HRV指標，HRV指標：採用時域和頻域兩種分析法，並請中醫師同時為其進行中醫體質症候診斷。 用SPSS軟體經統計分析來探討，以瞭解相關變化的差異與臨床意義，應用醫院資訊系統提供的大樣本病例資料和現代多元統計分析方法，建立中醫診斷基準的客觀化、量化的診斷指標，形成適合我國國情的、科學合理的疾病嚴重度評價標準。預期成效：藉由中西醫的結合研究，及科學的統計分析，可建立系統技術平台來協助中醫診斷基準之客觀化、量化的診斷指標；幫助中醫診斷工具的研發與改良；中醫診斷文獻探討及定義研究及中醫診斷現代機轉之探討。
關鍵字：心率變異數；APACHE II；APACHE III；SIRS；中醫體質

The Study of Chinese Medical Constitution in Cardiac Vascular Surgery Patient by Hrv and Apache

Lin, Kuo-Juei
China Medical University
Key Words: Heart Rate Variability; APACHE; Cytokine; SIRS; MODS; Chinese Medical ConstitutionBackground : Chinese medicine induces several kinds of Chinese medical constitution. The physical reactivity is often the change of bowels, endocrine and physical action that makes Chinese patho-physiologic diagnosis too subjective to communicate. These physical changes seem as close as the regulation of the autonomic nerve system (ANS). Objective: To objectify and standardize the Chinese Medicine diagnosis correlation, we relate the qualified measuring score and Heart rate variability (HRV) technique with traditional diagnosis by Chinese Medicine expert to find their relationship. Measurements: After the agreement of IRB, 25 peri- CABG surgery critically ill patients will be randomly assigned to be evaluated by APACHE II, III severity score, HRV, cytokine measurement and expert’s examination during the period of just before operation, 12 hours and 48 hours post surgery. We estimate the action of the ANS using heart rate variability through HRV through a PC-based examination system. Time domain and frequency domain analysis method will be applied by the same time. Through SPSS static analysis, we try to correlate the Chinese Medical Constitution with modern severity score and diagnosis technique to build up a objective diagnosis consensus.
關鍵字：Heart Rate Variability；APACHE；Cytokine；SIRS；MODS；Chinese Medical Constitution