心臟衰竭患者寸口脈波圖之分析

A STUDY OF RADIAL SPHYGMOGRAM IN HEART FAILURE PATIENTS

"傳統中醫認為寸口六部各配藏府，而左寸候心，心臟病患左寸脈象是否異於常人，值得研究。本文探討心臟衰竭患者寸口脈波圖之變化，並評估其臨床症狀之嚴重程度，是否與左寸脈波圖各項參數相關。由心臟內科病房篩選鬱血性心衰竭病患22 人，依症狀表現之嚴重度分為四級，並於健檢中心篩選年紀性別相當之20 人為對照組。兩組均使用汪氏脈波儀量取兩側寸口脈壓力波形，取主波高度上三分之一處的寬度為W ； T 為心舒縮週期； H1 為主波高度； H4 為降中峽高度； T1 為急性射血期； T4 為收縮期； T5 為舒張期，並以Student’s t-test 進行統計分析。研究結果顯示：兩組在左寸脈位比右寸脈位有更顯著的差異；寸、尺脈位較關位有更顯著的差異；脈波參數 W/T 在左寸沉、右寸沉、右尺浮等部位兩組間有極顯著差異（p < 0.001 ）。左寸候心之說，有其可能性，但究竟適用於那些範疇，尚待進一步研究。Traditional Chinese medicine dictates that the six positions of radial pulses are associated with the condition and activity of specific internal organs, and the left inch position is associated with that of the heart. It is important to understand whether the pulse characteristics of the heart patients at the left inch are truly different from that of the normal population. This study analyzes the radial sphygmogram variations in heart failure patients, and discusses whether the severity of heart symptoms is associated with specific variables in the left radial sphygmogram. Twenty-two patients with congestive heart failure are selected from the ward of Internal Medicine department, then categorized into four levels according to severity of clinical symptoms. The control group is comprised of 20 normal individuals of a similar mixture of age and gender, selected from the Health Examination Center. Dr. Wang’s Sphygmography is used to measure the waveform values of radial pulsation on both arms. In this study, “W” represents the width of the principle wave at one-third of its height, “T” represents the cardiac cycle, “H1” represents the height of the principle wave, “H4” represents the height of the dicrotic notch, “T1” represents the phase of acute ejection, “T4” represents the systolic phase, and “T5” represents the diastolic phase. Statistical analysis is performed with Student’s t-test. Results indicate that the difference in inch pulse values between the control group and the experimental group is more significant on the left side. The difference in pulse values is also more significant at the inch and cubit position than at the guan position. Significant difference is observed in the pulse parameter W/T between the control group and the experimental group at the left inch sunken pulse, right inch sunken pulse and right cubit floating pulse (p ≤ 0.001). Results of this study suggest that it is highly probable that the pulsation at the left inch position is associated with the condition of the heart. Further studies are required to determine the practical implication of this model. "