如何用心電散圖分析心律失常

1、2022-3-271中國(guó)中醫(yī)科學(xué)院望京醫(yī)院中國(guó)中醫(yī)科學(xué)院望京醫(yī)院李方潔李方潔2010.11.6 2010.11.6 廈門(mén)廈門(mén)2022-3-272n心電散點(diǎn)圖裝載于動(dòng)態(tài)心電分析系統(tǒng)n非線(xiàn)性混沌理論是其技術(shù)方法基礎(chǔ)n用于心率變異性分析n用于長(zhǎng)程心電數(shù)據(jù)的心律失常分析 長(zhǎng)程心電數(shù)據(jù)數(shù)的宏觀長(zhǎng)程心電數(shù)據(jù)數(shù)的宏觀“可視性可視性” 長(zhǎng)程心電數(shù)據(jù)中疑難心電圖的鑒別診斷長(zhǎng)程心電數(shù)據(jù)中疑難心電圖的鑒別診斷 心電散點(diǎn)圖的有關(guān)心電散點(diǎn)圖的有關(guān)概念心電散點(diǎn)圖的有關(guān)概念2022-3-273心電散點(diǎn)圖裝載于動(dòng)態(tài)心電分析系統(tǒng)心電散點(diǎn)圖裝載于動(dòng)態(tài)心電分析系統(tǒng)2022-3-2742022-3-2752022-3-2762022

2、-3-277n基于非線(xiàn)性混沌理論，依靠計(jì)算機(jī)快速運(yùn)算技術(shù)、對(duì)長(zhǎng)程心電RR間期數(shù)據(jù)進(jìn)行圖形表達(dá),用于心率變異性和心律失常診斷的方法心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源蝴蝶效應(yīng)” “蝴蝶效應(yīng)蝴蝶效應(yīng)” Butterfly Effect l Its a method using graphic to express long-time electrocardio-RR intervals data for heart rate variability and arrhythmia diagnosis, basing on nonlinear chaos theory and rely

3、ing on computer speed computing technology2022-3-278n心電散點(diǎn)圖伴隨混沌理論和計(jì)算機(jī)、及長(zhǎng)程心電記錄技術(shù)應(yīng)運(yùn)而生n心電散點(diǎn)圖來(lái)源于Lorenz 圖，也稱(chēng)Poincare圖，以E.N.Lorenz 和J.H.Poincare的姓氏名命，是研究系統(tǒng)非線(xiàn)性規(guī)律的方法，因圖形由散點(diǎn)組成，亦稱(chēng)散點(diǎn)圖n Electro cardio-scatter plot emerged with chaos theory and the technical n development of computer and long-term electrocardio-r

4、ecordingn Electro cardio-scatter plot comes from Lorenz plot, also called Poincare plot, n named after the family name of E.N.Lorenz and J.H.Poincare, and its a method n of studying system nonlinear law. Because the graph is made up of scatter, so its n also known as Scatter plot心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源心電散點(diǎn)圖的理

5、論基礎(chǔ)與來(lái)源2022-3-279 1903年P(guān)oincare在科學(xué)與方法一書(shū)中提出了Poincare猜想，指出“三體”問(wèn)題中，在一定范圍內(nèi)，其解是隨機(jī)的，意味著可能存在混沌的特性，從而成為世界上了解混沌存在可能性的第一人?；煦缋碚摰南闰?qū)Jules.Henri.Poincare(18541912）Pioneer of chaos theoryIn 1903, Poincare suggested Poincare conjecture in the book of Science and Method, that about “three-body” problem, in a certain

6、range, the solution is random, meaning there may be characteristics of chaos, thereby became the first people of understanding the possibility of Chaos existence in the world.心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源2022-3-2710 1948年Lorenz在進(jìn)行一項(xiàng)創(chuàng)新性氣象理論實(shí)驗(yàn)時(shí)，發(fā)現(xiàn)了“表面看似隨機(jī)，而實(shí)際上是按照嚴(yán)格而易于表達(dá)的規(guī)則運(yùn)動(dòng)的現(xiàn)象”“混沌理論之父混沌理論之父”Father of Ch

7、aos theory E.N.Lorenz(1917-2008)When making an innovative experiment on meteorological theory in 1948, Lorenz found that it is seemingly random in surface, but in fact it is the phenomenon moved in accordance with strictly and easily expressed rules 心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源2022-3-2711Lorenz發(fā)現(xiàn)混沌現(xiàn)象的

8、打印數(shù)據(jù)兩組曲線(xiàn)是怎樣分道揚(yáng)鑣的？The print data by which Lorenz discovered chaos phenomenon. How do the two curves diverge？ 1961年對(duì)混沌現(xiàn)象的 解釋終于出現(xiàn)了。l Finally the explanation to chaos phenomena appeared in 1961.心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源2022-3-2712n1963年Lorenz在大氣科學(xué)雜志上發(fā)表了一篇關(guān)于混沌理論的開(kāi)創(chuàng)性研究論文“確定性非周期流”n1975年Li-York在美國(guó)數(shù)學(xué)月刊發(fā)表“周期

9、3意味著混沌” 的文章，并給出混沌的數(shù)學(xué)定義（Li-Yorke定義）。自此，混沌成為科學(xué)的專(zhuān)業(yè)術(shù)語(yǔ) In 1963, Lorenz published a research paper on chaos theory Deterministic non- periodic flow in the Atmospheric Science magazine In 1975, Li-York published the article of period 3 implies chaos in Mathematical Monthly of the United States, and gives t

10、he mathematical definition of chaos (Li- Yorke definition). Since then, the chaos becomes a scientific jargon心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源2022-3-2713n發(fā)現(xiàn)并指出非線(xiàn)性的混沌系統(tǒng)是自然界的普遍規(guī)律，而線(xiàn)性行為只是其中的一部分（非線(xiàn)性系統(tǒng)包括線(xiàn)性、非線(xiàn)性行為及過(guò)渡于兩者之間的混沌行為 Discovered and pointed out that the non-linear chaos system is the universal law of nat

11、ure, while the linear behavior is only one part of the non-linear systems (non-linear systems include linear, nonlinear behavior and the chaos behavior transition between linear and non-linear.)心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源 理論貢獻(xiàn)理論貢獻(xiàn)2022-3-2714n揭示了非線(xiàn)性的混沌行為的某些特征與規(guī)律： 對(duì)初始狀態(tài)的敏感依賴(lài)性（蝴蝶效應(yīng)） 在確定的系統(tǒng)中表現(xiàn)為貌似隨機(jī)的行為（非周

12、期性） 混沌的特性還可以幾何形態(tài)表示出來(lái)（混沌的特性還可以幾何形態(tài)表示出來(lái)（“奇怪吸引子奇怪吸引子”） 子系統(tǒng)與整個(gè)系統(tǒng)相同（自相似性） 混沌的程度具有“可變性”（ 完全混沌、有限混沌、間歇混沌） Reveals the non-linear certain characteristics and law of chaos behavior Sensitive dependence on initial condition (butterfly effect) performance for the seemingly random behavior in the definitive sys

13、tem (aperiodicity) Chaos characteristic can also be expressed by geometry form (strange attractor) The subsystem is the same to the whole system (self-similarity) The degree of chaos has variability (complete chaos, limited chaos, intermittent chaos)心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源 理論貢獻(xiàn)理論貢獻(xiàn)2022-3-2715n提出了

14、研究非線(xiàn)性混沌規(guī)律的方法 圖形表達(dá)法圖形表達(dá)法LorenzLorenz圖（圖（ PoincarePoincare圖）圖） 非線(xiàn)性參數(shù)的估算非線(xiàn)性參數(shù)的估算復(fù)雜度、分維數(shù)、近似熵、李雅普諾夫指數(shù)復(fù)雜度、分維數(shù)、近似熵、李雅普諾夫指數(shù) Proposed the method of studying non-linear chaos law Graphic Expressions Lorenz plot (Poincare plot) Non-linear parameter estimation complexity, fractal dimension, approximate entropy,

15、 Lyapunov exponent心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源 理論貢獻(xiàn)理論貢獻(xiàn)2022-3-2716n1981年L.Glass等人在Science等雜志上發(fā)表研究結(jié)果： 在具有自律性的胚胎雞心肌細(xì)胞團(tuán)上，通過(guò)插入細(xì)胞內(nèi)的微電極給予電脈沖刺激，心搏模式出現(xiàn)了混沌特征倍周期分岔。 “在刺激和一小塊雞心之間可以建立許多不同的節(jié)律，我們使用非線(xiàn)性數(shù)學(xué)，能極好地了解不同節(jié)律和它們的排序”。In 1981, L. Glass and others published their research results in “Science”. In having auto-rhyt

16、hmical cardiac cell mass of embryonic chicken, gave electrical pulse stimulation through inserted intracellular microelectrode, heart beat emerged chaos characteristicperiod-doubling bifurcation. “Many different rhythms could be found between the stimulus and a small piece of chicken heart. We use n

17、on-linear mathematics to best understand the different rhythms and their sort.”心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源 心電學(xué)的應(yīng)用心電學(xué)的應(yīng)用2022-3-2717n1988年Leon Glass和Michael C.Mackey在From Clocks to Chaos The Rhythms of Life Princeton 中對(duì)人體生理和病理節(jié)律的研究，以及若干生物學(xué)實(shí)例與相關(guān)數(shù)學(xué)模型進(jìn)行了精辟的論述，受到自然科學(xué)界的廣泛關(guān)注。Nature和Science給予高度評(píng)價(jià)，指出正是在生物學(xué)中，非線(xiàn)

18、性科學(xué)可能最終找到其最重要的應(yīng)用。 In 1988, in the article of From Clocks to Chaos The Rhythms of Life Princeton , Leon Glass and Michael C. Mackey made a remarks in the studies of the rhythm of human physiological and pathological, and several biological examples and relevant mathematical model, which drew widespre

19、ad attention in natural science. The magazine of Nature and Science had given highly appreciation, that it is in biology, non-linear science may ultimately find its most important applications.心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源心電散點(diǎn)圖的理論基礎(chǔ)與來(lái)源 心電學(xué)的應(yīng)用心電學(xué)的應(yīng)用2022-3-2718早期記錄RR間期的心電散點(diǎn)圖Early Lorenz plot of recording RR intervals

20、 n1980年馬場(chǎng)康維等繪制并報(bào)告了一組臨床資料的Lorenz圖In 1980, Baba and others drew and reported a set of clinical data Lorenz plot2022-3-2719 1981年山崎秀樹(shù)等編制的Lorenz圖時(shí)間序列解析系統(tǒng)和Lorenz圖心電節(jié)律解析系統(tǒng)被用于醫(yī)學(xué)研究領(lǐng)域。早期記錄RR間期的心電散點(diǎn)圖軟件系統(tǒng)Software system of Lorenz plot to record RR intervalsIn 1981, Hideki Yamazaki and others made the time seri

21、es analysis system and electro cardio-rhythm analysis system of Lorenz plot, which were used in medical research.2022-3-2720n1982年、1990年Anan等分別發(fā)表了心房顫動(dòng)伴預(yù)激傳導(dǎo)及不同室性早搏的Lorenz圖，并對(duì)室性早搏圖形進(jìn)行解析。散點(diǎn)圖對(duì)心律失常圖形的解讀散點(diǎn)圖對(duì)心律失常圖形的解讀Graphic interpretation of arrhythmia In1982 and 1990, Anan and others respectively publish

22、ed the Lorenz plots of atrial fibrillation accompany with pre-excitation conduction and different ventricular premature contractions，and analyzed the Lorenz plots of ventricular premature contractions, which have become frequently cited articles by medical workers studied RR-Lorenz plot .AfAf伴預(yù)激Af w

23、ith pre-excitation室性早搏室性早搏ventricular premature contractions2022-3-2721發(fā)現(xiàn)散點(diǎn)圖的獨(dú)特電生理信息發(fā)現(xiàn)散點(diǎn)圖的獨(dú)特電生理信息Found the unique electrophysiological information of Lorenz plot 1991年Chishaki等用犬心臟制作的AF模型證明，當(dāng)刺激在右房、希式束或迷走經(jīng)神時(shí)，Lorenz圖上所顯示的房室結(jié)功能不應(yīng)期曲線(xiàn)分別呈不同形態(tài) In 1991, Chishaki and others proved by AF model made with a dog

24、 heart, when stimulated in the right atrium, the Greek-style beam or vagus, Lorenz plot showed that Functional Refractory Period of the Atrioventricular Node( AVNFRP) curves were different formsexcitement origin of Atria ventricular region AVNFRP stimulate vagus nerve2022-3-2722發(fā)現(xiàn)房顫伴寬QRS波的不同圖形Found

25、the different graphics of atrial fibrillation with wide QRSn1993年Chishaki等觀察了房顫伴室早與房顫伴差傳的圖形差異In 1993，Chishaki and others reported the difference between Af with VPC and Af compared with aberrant conduction in Lorenz plots2022-3-2723 在國(guó)內(nèi)n上世紀(jì)90年代郭繼鴻教授向國(guó)內(nèi)介紹了混沌理論、心臟電活動(dòng)中的混沌現(xiàn)象(郭繼鴻.混沌現(xiàn)象.臨床心電學(xué)雜志,1998,7(2):8

26、7 )，n郭成軍教授等探討運(yùn)用散點(diǎn)圖跟蹤心臟RR間期變化的方法與意義(郭成軍,胡大一,郭晉萍等.運(yùn)用Poincare 混沌圖跟蹤心臟RR 間期變化的研究.中國(guó)心臟起搏動(dòng)與心電生理雜志, 1996,138-140) n呂可誠(chéng)等制作并觀察了健康與心衰心電數(shù)據(jù)的散點(diǎn)圖特征(呂可誠(chéng),王繼業(yè)，常樹(shù)人等. 人體心臟搏動(dòng)的相空間吸引子.南開(kāi)大學(xué)學(xué)報(bào).自然科學(xué)版,1997,30 (3):61-64) 2022-3-2724n李方潔等對(duì)散點(diǎn)圖在長(zhǎng)程心電分析中的應(yīng)用進(jìn)行了探索。主要對(duì)1153例臨床常見(jiàn)心律失常的病例與傳統(tǒng)的動(dòng)態(tài)心電圖診斷進(jìn)行對(duì)比觀察，一部分指標(biāo)進(jìn)行了電生理對(duì)照觀察，證明了散點(diǎn)圖分析對(duì)HRV和心律失

27、常診斷和鑒別診斷的有用性，提出散點(diǎn)圖與動(dòng)態(tài)心電圖互補(bǔ)應(yīng)用對(duì)于提高心律失常分析確率和分析速度的意義，初步建立了散點(diǎn)圖分析心律失常方法。2022-3-2725心電散點(diǎn)圖作圖方法心電散點(diǎn)圖作圖方法The Method of making Lorenz plot P1P1P2P2P3P3P4P4P5P5P6P6P7P7RR1RR1RR5RR5RR6RR6RR7RR7RR8RR8RR2RR2RR3RR3RR4RR4Lorenz PlotLorenz Plot P1-P7 P1-P7X=RRnY=RRn+1YXLorenz plot of 24h RR interval of health adult 2

28、022-3-2726發(fā)現(xiàn)竇性心律圖形的多態(tài)性發(fā)現(xiàn)竇性心律圖形的多態(tài)性Found the polymorphism of sinus rhythm plot引自：李方潔，楊新春，白凈等. 1153例心律失常的Lorenz散點(diǎn)圖與動(dòng)態(tài)心電圖對(duì)比研究. 臨床心電學(xué)雜志.2006, 15(5):330-333Quoted from: Li Fang-Jie, Yang Xin-Chun, Bai Jing, et. al. The contrast analysis on diagnosis of 1153 arrhythmic patients between Lorenz plot and amb

29、ulatory electrocardiogram. Journal of Clinical Electrocardiology. 2006, 15 (5) :330-3332022-3-2727發(fā)現(xiàn)心律失常圖形的特異性發(fā)現(xiàn)心律失常圖形的特異性Found the specificity of arrhythmia plots 引自：李方潔，楊新春，白凈等. 1153例心律失常的Lorenz散點(diǎn)圖與動(dòng)態(tài)心電圖對(duì)比研究. 臨床心電學(xué)雜志.2006, 15(5):330-333Quoted from: Li Fang-Jie, Yang Xin-Chun, Bai Jing, et. al. The

30、 contrast analysis on diagnosis of 1153 arrhythmic patients between Lorenz plot and ambulatory electrocardiogram. Journal of Clinical Electrocardiology. 2006, 15 (5) :330-3332022-3-2728心電散點(diǎn)圖的命名心電散點(diǎn)圖的命名Naming of electrocardio-scatter plot A線(xiàn)線(xiàn)B線(xiàn)線(xiàn)B線(xiàn)線(xiàn)B線(xiàn)線(xiàn)B線(xiàn)線(xiàn)B線(xiàn)線(xiàn)一分布A distribution 二分布two distribution 四分布fou

31、r distribution三分布three distribution 三分布three distribution 五分布five distribution2022-3-2729診斷三要素診斷三要素three important diagnostic element 圖形形態(tài)圖形形態(tài)graph shape B(A)線(xiàn)斜率線(xiàn)斜率子圖數(shù)目子圖數(shù)目sub graph numberslope rate of B(A) line A distribution two distribution three distribution four distribution Slope=1 0 slope1 sl

32、ope=0Baseball racket shape grid-shape fan-shape心律失常診斷要素心律失常診斷要素Important diagnostic elements of arrhythmia2022-3-2730室上性早搏伴差傳正常竇性心搏室上性早搏室性早搏陣發(fā)室早二聯(lián)律持續(xù)室早二聯(lián)律心律失常診斷模型心律失常診斷模型Arrhythmia diagnostic model2022-3-2731II竇房與竇房與II度度II型型房室阻滯房室阻滯心房顫動(dòng)心房顫動(dòng)B線(xiàn)斜率線(xiàn)斜率0.11心房撲動(dòng)房顫合并房撲撲房顫伴室早室上早合并室早心律失常診斷模型心律失常診斷模型Arrhythmia diagnostic model2022-3-2732寬QRS波鑒別診斷B線(xiàn)斜率為線(xiàn)斜率為0.23B-linear slop =0.23B線(xiàn)斜率為線(xiàn)斜率為0B-linear slop =0B線(xiàn)斜率為線(xiàn)斜率為-0.23B-linear slop =-0.23心律失常診斷模型心律失常診斷模型Arrhythmia diagnostic model2022-3-2733心律失常診斷模型心律失常診斷模型Ar