A Feasibility Study of Evaluation Hypotension by Arterial Pressure and Heart Rate Variability During Hemodialysis

• Main Authors: CHEN,SHI-HAN, 陳詩涵
• Other Authors: DU, YI-CYUN
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/jmape9

碩士 === 南臺科技大學 === 電機工程系 === 107 === The number of ESRD patients in Taiwan had exceeded 85,000 in 2016, and is increasing at the rates of 6% each year. Complications of hemodialysis (HD) treatment include hypotension, hypertension, imbalance syndrome, chest pain, etc. In view of that the incidence of hypotension ranges from 25% to 50%, it is the most common complication during hemodialysis. Repeated hypotension causes blood stagnation and leads to excessive heart workload of patients. Moreover, clinical studies proposed that the incidence of hypotension had a high correlation with the rate of mortality. Heart rate (HR) and blood flow are affected by blood pressure variability (BPV), but the clinical blood flow rate is usually measured by ultrasound technology that is not easy to perform in HD treatment. HR measurement also requires the patients during hemodialysis to wear additional devices and is easily affected by patients’ movement. Furthermore, some HD patients developed restlessness, so HR measurement was less suitable for HD patients. Thence, in clinical practice, it could only rely on the BP measurement by the nursing staff every 30 to 60 minutes or the patient's discomfort complaint to detect the patient's hypotension. This study focused on the arterial pressure (AP), a physiological parameter which could be measured continuously through a dialysis machine, and discussed the feasibility of AP and HR as the evaluation for hypotension during hemodialysis. In this study, the records of HR and AP were segmented according to 3 risks of hypotension, and the rule-based evaluation for hypotension was established. The clinical trial results of 12 HD patients show that the number of abnormal HRV (ANHRV) and APV (ANAPV) could evaluate the risk of hypotension, with an accuracy of 85% and 80%, respectively. Further, it was proposed a rule-based method for two parameters. The result shows that using two parameters could provide the 90% accuracy to the evaluation of hypotension. The results indicated that AP and HR from the dialysis machine could be a predictor for hypotension during hemodialysis to provide an immediate aid of evaluation for the nursing staff to enhance the safety of hemodialysis.