不可逆之呼吸停止昏迷與腦死病人其心率變異度在臨床症狀之相關研究

The heart rate variability analysis of Irreversible Apneic Coma and brain death via Poincare' plot

胡博凱(Bo-Kai Hu)

指導教授 ： 謝建興

元智大學/工程學院/機械工程學系/碩士(2006年)

https://doi.org/10.6838/YZU.2006.00014

摘要

近年來由於器官捐贈盛行，腦死的判定相對重要，目前正規法定程序是針對器官捐贈者利用呼吸停止測試及腦幹測試進行腦死判定， 同樣是嚴重腦傷不可逆呼吸停止昏迷(IAC)的病人，但並未簽署器官捐贈的患者，法定上不能進行呼吸停止測試之結果宣告病人的死亡。有研究指出臨床上無論是IAC或腦死一旦發生「自主神經風暴」後，將發生心臟自主神經控制失效的情況。
本研究主要目的在探討IAC與腦死患者其心率變異度的關係性，本研究利用能量頻譜分析(HF/LF, HF/TF)和非線性的Poincare' plot 分析方法求得SD1、SD2、SD1/SD2等參數，如果能證明IAC病人與正常人或是腦死心率變異度的相關性，即可根據此特性建立生理指標，而在臨床上診斷就能提早找出腦幹衰竭的時間點，改變腦死判定的方式，臨床上以便後續積極的進行器官移植或是後續安寧緩和照顧。
實驗結果：觀察腦死、IAC、一般病患與正常人Poincare' plot圖形，發現腦死跟IAC群組特徵圖形為螺旋葉片形，且面積極小；正常人特徵圖形為流星形，且面積較大。而一般病人沒有特徵圖形，利用統計學證明三個主群組(IAC、正常人和一般病人)間具有極大差異性，並進一步利用Mann-Whitney檢定腦死與IAC病人的差異，分析結果兩者並無差異。

關鍵字

不可逆之呼吸停止昏迷 ； 腦死 ； 心率變異度

並列摘要

The purpose of this research is to find the heart rate variability (HRV) of irreversible apneic coma (IAC) and brain death for the clinical correlation research. IAC, or the rather controversial term - brain death, is defined as the irreversible loss of function of the brain. Sympathetic storm, a cardiovascular hyperdynamic state occurring in the process of brain stem failure, has been well studied in animal models. Observations of hypertension and tachycardia due to intense vasoconstriction in IAC patients have been described in clinical settings. The phenomenon of sympathetic storm was also mentioned by researchers after introducing the HRV, suggesting its contributory potential to the diagnosis of IAC. The Poincare' plots are one of the non-linear analysis of HRV. We calculate Poincare' plot index (SD1, SD2 and area) and frequency index (HF/LF, HF/TF) in order to obtain the relationship between HRV and Autonomic nervous system. Observing the Poincare' plots of three groups (IAC, normal coma and normal), We find the shapes of IAC and brain death patients are fan and area are smaller, but shapes of normal people are comet and area are bigger. Finally we use statistics to discuss the difference of Poincare' plots with three groups.

並列關鍵字

heart rate variability ； Irreversible Apneic Coma ； autonomic nervous system

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