血壓測量方式的比較及血壓與尿中白蛋白關係之研究

血壓在獸醫的應用可以在於診斷、治療及研究，更可以用於病畜的臨床評估。尿中微量蛋白和高血壓的惡化更有相關聯。第一部分研究的目的是評估臨床上兩種間接的血壓測量方式的準確性和效率。第二部份是使用人類尿中白蛋白的半定量試紙檢測狗的微量蛋白尿，再進一步分析微量蛋白尿和血壓的關係。使用都卜勒血壓計測量分別兩次的血壓平均值為156±38.2mmHg和150±34.1mmHg。使用共振式血壓計測量分別兩次的血壓平均值為138±36.9mmHg和133±33.5mmHg。在同次的血壓測量的兩種方法中存在著顯著的差異(P<0.001)。在同一隻狗的五次連續測量的血壓的變異係數中，在都卜勒血壓計的兩次測量中分別為4.1±3.2%和3.1±1.7%，相對的在共振式血壓計的兩次測量中分別為18.7±11.3%和17.2±12.5%。兩種方法的變異係數在兩次測量中皆有統計上顯著的差異(P<0.001)。在前後兩次使用都卜勒血壓計的連續五次測量中皆可以在6分鐘內操作完畢，但是使用共振式血壓計卻需要費時15分鐘以上。這部分研究的結果顯示在臨床上都卜勒血壓計比共振式血壓計更能提供精確和有效得測量。白蛋白結合染料試紙在範圍濃度(10mg到150mg)內的犬白蛋白的結合率達到100%。但是犬球蛋白的濃度達到80mg/L時會使試紙出現偽陽性的結果。臨床上100隻健康的犬隻，其中61隻沒有微量白蛋白尿，另外39隻呈現陽性反應。微量白蛋白尿和血壓的狀態在統計沒有相關性(P=0.71)。而尿中微量白蛋白使用尿中白蛋白和肌酸酐的比值來表示，在100隻狗中，53隻沒有微量白蛋白尿，45隻為白蛋白尿，最後2隻為蛋白尿。尿中白蛋白和肌酸酐的比值和血壓的狀態在統計沒有相關性(P=0.65)。

關鍵字

狗；血壓；都卜勒；共振式；微量白蛋白尿

並列摘要

Systemic blood pressure (SBP) level is a reference for diagnosis, treatment and clinical research in veterinary medicine and is used extensively in veterinary patients as a part of clinical assessment. Microalbuminuria is associated with increased risk of deterioration of hypertension. The aim of first part of the study was to evaluate the precision and efficiency of 2 indirect methods of systemic blood pressure measurement in conscious dogs in a clinical setting. Secondly, to evaluate use of semiquantitative test strips that was designed for human urine albumin in detection of canine microalbuminuria, and to evaluate association between microalbuminuria and systemic blood pressure (SBP) in dogs. The mean SBP values, measured by Doppler sphygmomanometry on 2 separate occasions, were 156  38.2 mmHg and 150  34.1 mmHg, respectively. Using oscillometry, the mean SBP values were 138  36.9 mm Hg and 133  33.5 mm Hg on 2 separate occasions. There were significant differences between the SBP readings for both methods on the same occasion (P<0.001). The coefficients of variance from 5 consecutive measurements in the same dog obtained by Doppler sphygmomanometry on the 2 separate occasions were 4.1  3.2% and 3.1  1.7%; that of the oscillometric method on the 2 separate occasions were 18.7 ± 11.3% and 17.2 ± 12.5%. The coefficients of variance of these 2 methods were statistically different on each occasion (P<0.001). Five consecutive SBP readings were obtained for each dog within 6 minutes on both occasions using Doppler sphygmomanometry. More than 15 minutes was required to complete 5 consecutive SBP readings by oscillometric sphygmomanometry for all dogs on each occasion. The results of this part of the study indicate that Doppler sphygmomanometry provides more efficient and precise measurements of the SBP level than oscillometric testing in conscious dogs in a clinical setting. The albumin-binding dye dipsticks for detecting canine albumin controls at the concentrations within assigned ranges (10 to 150 mg/L) were 100% concordance. However, canine globulin concentrations over 80 mg/L were detected false positively as presence of albumin. Off 100 clinically healthy dogs, 61 had negative result of microalbuminuria test, 39 were positive. Microalbuminuria was not associated with the blood pressure status (P = 0.71). Whereas microalbuminuria presented using urine albumin: creatinine ratio (UACR), 53 of 100 dogs did not have microalbuminuria, 45 were albuminuric, and 2 had proteinuria. The UACR was not associated with the blood pressure status (P = 0.65).

並列關鍵字

dog ； blood pressure ； Doppler ； oscillometry ； microalbuminuria

參考文獻

Chapter one

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血壓測量方式的比較及血壓與尿中白蛋白關係之研究

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