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相關文獻
- Heart Rate Variability as an Assessment of Acute Rejection after Heart Transplantation
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- Anesthetic Management in Orthotopic Cardiac Transplant Recipients
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題 名 | Heart Rate Variability as an Assessment of Acute Rejection after Heart Transplantation=用心率變異度評估心臟移植後之急性排斥 |
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作 者 | 周正亮; 高念慈; 郭博昭; 劉作仁; 詹瑞棋; | 書刊名 | 中華醫學雜誌 |
卷 期 | 61:10 1998.10[民87.10] |
頁 次 | 頁561-567 |
分類號 | 416.262 |
關鍵詞 | 急性排斥; 心率變異度分析; 心臟移植; Acute rejection; Heart rate variability; Heart transplantation; |
語 文 | 英文(English) |
中文摘要 | 背景 近年來心臟移植手術已經成為心臟病末期病人的標準治療之一,術後急性 排斥的控制對病人的存活率有直接的影響,過去皆採用心內膜穿刺切片來偵測急性排斥的發 生,而心內膜穿刺為一種侵襲性的步驟,本身有許多缺點。本實驗的目的為評估心率變異度 與心臟移植後之急性排斥之相關性,望能找到一種非侵襲性的例行診斷工具,來偵測早期 急行排斥。 方法 我們追蹤6位自1997年5月至1998年5月於本院接受心臟移植手術的患者,於例行心內 膜穿刺切片的前晚5:00pm,進行心率變異度分析,並與心內膜穿刺切片的結果加以比較。 結果 總數48次心內膜穿刺切片的結果中,42次(87.5%)無急性排斥的現象;4次呈現1A的排 斥現象;1次呈現1B的排斥現象;1次呈現3A的排斥現象。同時我們發現3A排斥現象的患者 ,其心率變異度呈現明顯上揚的情形。 結論 心率變異度分析用於監測心臟移植術後之急性排斥具有臨床應用價值。本實驗中個案 數較少,無法探討心率變異度分析應用之信度及效度,將來待個案累積至相當數目,我們將 作進一步探討。 |
英文摘要 | Background. Orthotopic heart transplantation is currently a widely accepted treatment for end-stage heart disease. Early detection and adequate therapy of acute rejection increases the survival rate. Currently, the most reliable technique for the detection of acute cardiac rejection(ACR) is endomyocardial biopsy(EMB), which is an invasive procedure with some intrinsic problems. The purpose of this study was to assess heart rate variability(HRV) as a noninvasive procedure for frequent monitoring of ACR. Methods. Six consecutive orthotopic cardiac transplant recipients were prospectively recruited into this study. The follow-up periods ranged from seven to 359 days(median; 146 days). A precordial electrocardiograh(ECG) of 288 seconds was records at 5:00 PM before the patient underwent EMB. The results form the frequency domain analysis of the ECG signals were evaluated to correlate with the findings form EMB. Results. Of 48 EMBs, 42(87.5%) showed no evidence of rejection, four showed mild focal ACR(EMB grade 1A), one mild diffuse ACR(1B) and one moderate plurifocal ACR(3A). There was no moderate focal ACR(2), severe diffuse ACR(3B) or severe ACR(4). Correlation between ACR(3A) and a significant increase in HRV with a corresponding 'broad-band' or bell-shaped pattern on the power spectrum was noted. Conclusions. Our study in consecutive cardiac transplant recipients indicates that the changes in HRV provide clinicians with a new concept for heart transplant monitoring. Further study is needed to verify clinical utility. |
本系統中英文摘要資訊取自各篇刊載內容。