如何用心电散图分析心律失常

1、2022-3-271中国中医科学院望京医院中国中医科学院望京医院李方洁李方洁2010.11.6 2010.11.6 厦门厦门2022-3-272n心电散点图装载于动态心电分析系统n非线性混沌理论是其技术方法基础n用于心率变异性分析n用于长程心电数据的心律失常分析 长程心电数据数的宏观长程心电数据数的宏观“可视性可视性” 长程心电数据中疑难心电图的鉴别诊断长程心电数据中疑难心电图的鉴别诊断 心电散点图的有关心电散点图的有关概念心电散点图的有关概念2022-3-273心电散点图装载于动态心电分析系统心电散点图装载于动态心电分析系统2022-3-2742022-3-2752022-3-2762022

2、-3-277n基于非线性混沌理论，依靠计算机快速运算技术、对长程心电RR间期数据进行图形表达,用于心率变异性和心律失常诊断的方法心电散点图的理论基础与来源心电散点图的理论基础与来源蝴蝶效应” “蝴蝶效应蝴蝶效应” 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心电散点图伴随混沌理论和计算机、及长程心电记录技术应运而生n心电散点图来源于Lorenz 图，也称Poincare图，以E.N.Lorenz 和J.H.Poincare的姓氏名命，是研究系统非线性规律的方法，因图形由散点组成，亦称散点图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心电散点图的理论基础与来源心电散点图的理

5、论基础与来源2022-3-279 1903年Poincare在科学与方法一书中提出了Poincare猜想，指出“三体”问题中，在一定范围内，其解是随机的，意味着可能存在混沌的特性，从而成为世界上了解混沌存在可能性的第一人。混沌理论的先驱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.心电散点图的理论基础与来源心电散点图的理论基础与来源2022-3-2710 1948年Lorenz在进行一项创新性气象理论实验时，发现了“表面看似随机，而实际上是按照严格而易于表达的规则运动的现象”“混沌理论之父混沌理论之父”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 心电散点图的理论基础与来源心电散点图的理论基础与来源2022-3-2711Lorenz发现混沌现象的

8、打印数据两组曲线是怎样分道扬镳的？The print data by which Lorenz discovered chaos phenomenon. How do the two curves diverge？ 1961年对混沌现象的 解释终于出现了。l Finally the explanation to chaos phenomena appeared in 1961.心电散点图的理论基础与来源心电散点图的理论基础与来源2022-3-2712n1963年Lorenz在大气科学杂志上发表了一篇关于混沌理论的开创性研究论文“确定性非周期流”n1975年Li-York在美国数学月刊发表“周期

9、3意味着混沌” 的文章，并给出混沌的数学定义（Li-Yorke定义）。自此，混沌成为科学的专业术语 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心电散点图的理论基础与来源心电散点图的理论基础与来源2022-3-2713n发现并指出非线性的混沌系统是自然界的普遍规律，而线性行为只是其中的一部分（非线性系统包括线性、非线性行为及过渡于两者之间的混沌行为 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.)心电散点图的理论基础与来源心电散点图的理论基础与来源 理论贡献理论贡献2022-3-2714n揭示了非线性的混沌行为的某些特征与规律： 对初始状态的敏感依赖性（蝴蝶效应） 在确定的系统中表现为貌似随机的行为（非周

12、期性） 混沌的特性还可以几何形态表示出来（混沌的特性还可以几何形态表示出来（“奇怪吸引子奇怪吸引子”） 子系统与整个系统相同（自相似性） 混沌的程度具有“可变性”（ 完全混沌、有限混沌、间歇混沌） 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)心电散点图的理论基础与来源心电散点图的理论基础与来源 理论贡献理论贡献2022-3-2715n提出了

14、研究非线性混沌规律的方法 图形表达法图形表达法LorenzLorenz图（图（ PoincarePoincare图）图） 非线性参数的估算非线性参数的估算复杂度、分维数、近似熵、李雅普诺夫指数复杂度、分维数、近似熵、李雅普诺夫指数 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心电散点图的理论基础与来源心电散点图的理论基础与来源 理论贡献理论贡献2022-3-2716n1981年L.Glass等人在Science等杂志上发表研究结果： 在具有自律性的胚胎鸡心肌细胞团上，通过插入细胞内的微电极给予电脉冲刺激，心搏模式出现了混沌特征倍周期分岔。 “在刺激和一小块鸡心之间可以建立许多不同的节律，我们使用非线性数学，能极好地了解不同节律和它们的排序”。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.”心电散点图的理论基础与来源心电散点图的理论基础与来源 心电学的应用心电学的应用2022-3-2717n1988年Leon Glass和Michael C.Mackey在From Clocks to Chaos The Rhythms of Life Princeton 中对人体生理和病理节律的研究，以及若干生物学实例与相关数学模型进行了精辟的论述，受到自然科学界的广泛关注。Nature和Science给予高度评价，指出正是在生物学中，非线

18、性科学可能最终找到其最重要的应用。 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.心电散点图的理论基础与来源心电散点图的理论基础与来源 心电学的应用心电学的应用2022-3-2718早期记录RR间期的心电散点图Early Lorenz plot of recording RR intervals

20、 n1980年马场康维等绘制并报告了一组临床资料的Lorenz图In 1980, Baba and others drew and reported a set of clinical data Lorenz plot2022-3-2719 1981年山崎秀树等编制的Lorenz图时间序列解析系统和Lorenz图心电节律解析系统被用于医学研究领域。早期记录RR间期的心电散点图软件系统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等分别发表了心房颤动伴预激传导及不同室性早搏的Lorenz图，并对室性早搏图形进行解析。散点图对心律失常图形的解读散点图对心律失常图形的解读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伴预激Af w

23、ith pre-excitation室性早搏室性早搏ventricular premature contractions2022-3-2721发现散点图的独特电生理信息发现散点图的独特电生理信息Found the unique electrophysiological information of Lorenz plot 1991年Chishaki等用犬心脏制作的AF模型证明，当刺激在右房、希式束或迷走经神时，Lorenz图上所显示的房室结功能不应期曲线分别呈不同形态 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发现房颤伴宽QRS波的不同图形Found

25、the different graphics of atrial fibrillation with wide QRSn1993年Chishaki等观察了房颤伴室早与房颤伴差传的图形差异In 1993，Chishaki and others reported the difference between Af with VPC and Af compared with aberrant conduction in Lorenz plots2022-3-2723 在国内n上世纪90年代郭继鸿教授向国内介绍了混沌理论、心脏电活动中的混沌现象(郭继鸿.混沌现象.临床心电学杂志,1998,7(2):8

26、7 )，n郭成军教授等探讨运用散点图跟踪心脏RR间期变化的方法与意义(郭成军,胡大一,郭晋萍等.运用Poincare 混沌图跟踪心脏RR 间期变化的研究.中国心脏起搏动与心电生理杂志, 1996,138-140) n吕可诚等制作并观察了健康与心衰心电数据的散点图特征(吕可诚,王继业，常树人等. 人体心脏搏动的相空间吸引子.南开大学学报.自然科学版,1997,30 (3):61-64) 2022-3-2724n李方洁等对散点图在长程心电分析中的应用进行了探索。主要对1153例临床常见心律失常的病例与传统的动态心电图诊断进行对比观察，一部分指标进行了电生理对照观察，证明了散点图分析对HRV和心律失

27、常诊断和鉴别诊断的有用性，提出散点图与动态心电图互补应用对于提高心律失常分析确率和分析速度的意义，初步建立了散点图分析心律失常方法。2022-3-2725心电散点图作图方法心电散点图作图方法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发现窦性心律图形的多态性发现窦性心律图形的多态性Found the polymorphism of sinus rhythm plot引自：李方洁，杨新春，白净等. 1153例心律失常的Lorenz散点图与动态心电图对比研究. 临床心电学杂志.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发现心律失常图形的特异性发现心律失常图形的特异性Found the specificity of arrhythmia plots 引自：李方洁，杨新春，白净等. 1153例心律失常的Lorenz散点图与动态心电图对比研究. 临床心电学杂志.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心电散点图的命名心电散点图的命名Naming of electrocardio-scatter plot A线线B线线B线线B线线B线线B线线一分布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诊断三要素诊断三要素three important diagnostic element 图形形态图形形态graph shape B(A)线斜率线斜率子图数目子图数目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心律失常诊断要素心律失常诊断要素Important diagnostic elements of arrhythmia2022-3-2730室上性早搏伴差传正常窦性心搏室上性早搏室性早搏阵发室早二联律持续室早二联律心律失常诊断模型心律失常诊断模型Arrhythmia diagnostic model2022-3-2731II窦房与窦房与II度度II型型房室阻滞房室阻滞心房颤动心房颤动B线斜率线斜率0.11心房扑动房颤合并房扑扑房颤伴室早室上早合并室早心律失常诊断模型心律失常诊断模型Arrhythmia diagnostic model2022-3-2732宽QRS波鉴别诊断B线斜率为线斜率为0.23B-linear slop =0.23B线斜率为线斜率为0B-linear slop =0B线斜率为线斜率为-0.23B-linear slop =-0.23心律失常诊断模型心律失常诊断模型Arrhythmia diagnostic model2022-3-2733心律失常诊断模型心律失常诊断模型Ar