Kamijo Yuka, Kanda Eiichiro, Horiuchi Hayato, Kounoue Noriyuki, Ono Keisuke, Maeda Keizo, Yanai Akane, Honda Kazuya, Tsujimoto Ryuji, Yanagi Mai, Ishibashi Yoshitaka, Yoshida Masayuki
Department of Nephrology, Japanese Red Cross Medical Center, 4-1-22 Hiroo Shibuya-Ku, Tokyo, Japan.
Department of Life Science and Bioethics, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan.
Clin Exp Nephrol. 2018 Jun;22(3):677-683. doi: 10.1007/s10157-017-1499-1. Epub 2017 Nov 10.
Patients with end-stage renal disease undergoing hemodialysis (HD) have an elevated risk of cardiovascular disease-related morbidity and mortality. To prevent from such a life-threatening event, the continuous blood pressure (BP) monitoring system may contribute to detect BP decline in early stages and may help to do appropriate disposal. Our research team has introduced an electronic stethoscope (Asahi Kasei Co, Ltd., Tokyo, Japan), which translates sound intensity of Arteriovenous Fistula (AVF) to BP data using the technique of Fourier transformation that can predict continuous BP non-invasively. This study, we investigated whether electronic stethoscope-guided estimated BP (e-BP) would actually reflect systolic BP measured by sphygmomanometer (s-BP), and whether e-BP could predict fall of BP during HD.
Twenty-six patients who underwent HD treatment in our hospital were evaluated prospectively. We obtained sound intensity data from the electronic stethoscope which was equipped with the return line of HD. Then, the data were translated into e-BP data to be compared with s-BP. Correlation of total of 315 data sets obtained from each method was examined. An accuracy of diagnosis of intra-dialytic hypotension (IDH) was evaluated.
Total of 315 data sets were obtained. A close correlation was observed between e-BP and s-BP (r = 0.887, p < 0.0001). Sensitivity and positive predictive value of predicted-BP for detection of IDH was 90 and 81.3%, respectively.
Electronic stethoscope-guided BP measurement would be helpful for real-time diagnosis of BP fall in HD patients. Further investigations are needed.
接受血液透析（HD）的终末期肾病患者发生心血管疾病相关发病和死亡的风险升高。为预防此类危及生命的事件，连续血压（BP）监测系统可能有助于早期检测血压下降，并有助于进行适当处理。我们的研究团队引入了一种电子听诊器（日本东京旭化成株式会社），该听诊器利用傅里叶变换技术将动静脉内瘘（AVF）的声音强度转换为血压数据，从而能够无创地预测连续血压。在本研究中，我们调查了电子听诊器引导下的估计血压（e-BP）是否真的能反映用血压计测量的收缩压（s-BP），以及e-BP是否能预测血液透析期间的血压下降。
对在我院接受HD治疗的26例患者进行前瞻性评估。我们从配备了HD回流管路的电子听诊器获取声音强度数据。然后，将这些数据转换为e-BP数据，以便与s-BP进行比较。检查了从每种方法获得的总共315个数据集的相关性。评估了透析中低血压（IDH）的诊断准确性。
共获得315个数据集。观察到e-BP与s-BP之间存在密切相关性（r = 0.887，p < 0.0001）。预测血压检测IDH的敏感性和阳性预测值分别为90%和81.3%。
电子听诊器引导下的血压测量有助于实时诊断HD患者的血压下降。还需要进一步研究。
