如何用心電散圖分析心律失常

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

2、-3-277n基于非線性混沌理論，依靠計算機快速運算技術、對長程心電RR間期數(shù)據(jù)進行圖形表達,用于心率變異性和心律失常診斷的方法心電散點圖的理論基礎與來源心電散點圖的理論基礎與來源蝴蝶效應” “蝴蝶效應蝴蝶效應” 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心電散點圖伴隨混沌理論和計算機、及長程心電記錄技術應運而生n心電散點圖來源于Lorenz 圖，也稱Poincare圖，以E.N.Lorenz 和J.H.Poincare的姓氏名命，是研究系統(tǒng)非線性規(guī)律的方法，因圖形由散點組成，亦稱散點圖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心電散點圖的理論基礎與來源心電散點圖的理

5、論基礎與來源2022-3-279 1903年Poincare在科學與方法一書中提出了Poincare猜想，指出“三體”問題中，在一定范圍內，其解是隨機的，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。混沌理論的先驅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.心電散點圖的理論基礎與來源心電散點圖的理論基礎與來源2022-3-2710 1948年Lorenz在進行一項創(chuàng)新性氣象理論實驗時，發(fā)現(xiàn)了“表面看似隨機，而實際上是按照嚴格而易于表達的規(guī)則運動的現(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 心電散點圖的理論基礎與來源心電散點圖的理論基礎與來源2022-3-2711Lorenz發(fā)現(xiàn)混沌現(xiàn)象的

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

9、3意味著混沌” 的文章，并給出混沌的數(shù)學定義（Li-Yorke定義）。自此，混沌成為科學的專業(yè)術語 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心電散點圖的理論基礎與來源心電散點圖的理論基礎與來源2022-3-2713n發(fā)現(xiàn)并指出非線性的混沌系統(tǒng)是自然界的普遍規(guī)律，而線性行為只是其中的一部分（非線性系統(tǒng)包括線性、非線性行為及過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.)心電散點圖的理論基礎與來源心電散點圖的理論基礎與來源 理論貢獻理論貢獻2022-3-2714n揭示了非線性的混沌行為的某些特征與規(guī)律： 對初始狀態(tài)的敏感依賴性（蝴蝶效應） 在確定的系統(tǒng)中表現(xiàn)為貌似隨機的行為（非周

12、期性） 混沌的特性還可以幾何形態(tài)表示出來（混沌的特性還可以幾何形態(tài)表示出來（“奇怪吸引子奇怪吸引子”） 子系統(tǒng)與整個系統(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)心電散點圖的理論基礎與來源心電散點圖的理論基礎與來源 理論貢獻理論貢獻2022-3-2715n提出了

14、研究非線性混沌規(guī)律的方法 圖形表達法圖形表達法LorenzLorenz圖（圖（ PoincarePoincare圖）圖） 非線性參數(shù)的估算非線性參數(shù)的估算復雜度、分維數(shù)、近似熵、李雅普諾夫指數(shù)復雜度、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心電散點圖的理論基礎與來源心電散點圖的理論基礎與來源 理論貢獻理論貢獻2022-3-2716n1981年L.Glass等人在Science等雜志上發(fā)表研究結果： 在具有自律性的胚胎雞心肌細胞團上，通過插入細胞內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，我們使用非線性數(shù)學，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.”心電散點圖的理論基礎與來源心電散點圖的理論基礎與來源 心電學的應用心電學的應用2022-3-2717n1988年Leon Glass和Michael C.Mackey在From Clocks to Chaos The Rhythms of Life Princeton 中對人體生理和病理節(jié)律的研究，以及若干生物學實例與相關數(shù)學模型進行了精辟的論述，受到自然科學界的廣泛關注。Nature和Science給予高度評價，指出正是在生物學中，非線

18、性科學可能最終找到其最重要的應用。 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.心電散點圖的理論基礎與來源心電散點圖的理論基礎與來源 心電學的應用心電學的應用2022-3-2718早期記錄RR間期的心電散點圖Early Lorenz plot of recording RR intervals

20、 n1980年馬場康維等繪制并報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年山崎秀樹等編制的Lorenz圖時間序列解析系統(tǒng)和Lorenz圖心電節(jié)律解析系統(tǒng)被用于醫(yī)學研究領域。早期記錄RR間期的心電散點圖軟件系統(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)表了心房顫動伴預激傳導及不同室性早搏的Lorenz圖，并對室性早搏圖形進行解析。散點圖對心律失常圖形的解讀散點圖對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)散點圖的獨特電生理信息發(fā)現(xiàn)散點圖的獨特電生理信息Found the unique electrophysiological information of Lorenz plot 1991年Chishaki等用犬心臟制作的AF模型證明，當刺激在右房、希式束或迷走經(jīng)神時，Lorenz圖上所顯示的房室結功能不應期曲線分別呈不同形態(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 在國內n上世紀90年代郭繼鴻教授向國內介紹了混沌理論、心臟電活動中的混沌現(xiàn)象(郭繼鴻.混沌現(xiàn)象.臨床心電學雜志,1998,7(2):8

26、7 )，n郭成軍教授等探討運用散點圖跟蹤心臟RR間期變化的方法與意義(郭成軍,胡大一,郭晉萍等.運用Poincare 混沌圖跟蹤心臟RR 間期變化的研究.中國心臟起搏動與心電生理雜志, 1996,138-140) n呂可誠等制作并觀察了健康與心衰心電數(shù)據(jù)的散點圖特征(呂可誠,王繼業(yè)，常樹人等. 人體心臟搏動的相空間吸引子.南開大學學報.自然科學版,1997,30 (3):61-64) 2022-3-2724n李方潔等對散點圖在長程心電分析中的應用進行了探索。主要對1153例臨床常見心律失常的病例與傳統(tǒng)的動態(tài)心電圖診斷進行對比觀察，一部分指標進行了電生理對照觀察，證明了散點圖分析對HRV和心律失

27、常診斷和鑒別診斷的有用性，提出散點圖與動態(tài)心電圖互補應用對于提高心律失常分析確率和分析速度的意義，初步建立了散點圖分析心律失常方法。2022-3-2725心電散點圖作圖方法心電散點圖作圖方法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散點圖與動態(tài)心電圖對比研究. 臨床心電學雜志.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散點圖與動態(tài)心電圖對比研究. 臨床心電學雜志.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心電散點圖的命名心電散點圖的命名Naming of electrocardio-scatter plot A線線B線線B線線B線線B線線B線線一分布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)線斜率線斜率子圖數(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心房顫動B線斜率線斜率0.11心房撲動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線斜率為線斜率為0.23B-linear slop =0.23B線斜率為線斜率為0B-linear slop =0B線斜率為線斜率為-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