本文選題：心電圖時間間期　切入點(diǎn)：血壓(BP)　出處：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:自主神經(jīng)系統(tǒng)(ANS)在心血管的生理調(diào)節(jié)方面扮演著重要角色。ANS失衡可能使心血管功能受到損傷,導(dǎo)致多種心血管疾病的發(fā)生、發(fā)展。心電圖間期信號和動脈血壓信號受自主神經(jīng)的調(diào)節(jié),呈現(xiàn)出一定的動力學(xué)特性,如心率變異性(HRV)和血壓變異性(BPV)。這些心血管生理信號的動力學(xué)相互作用包含著自主神經(jīng)調(diào)節(jié)的重要信息。本研究擬以連續(xù)心電圖間期序列和收縮壓序列(SBP)為基礎(chǔ),分別進(jìn)行RR間期(RRI)與SBP以及RRI與QT間期(QTI)的短時聯(lián)合分析,通過表征RRI-SBP以及RRI-QTI的因果相互作用,探討自主神經(jīng)狀態(tài)的無創(chuàng)評估方法。方法:選用PhysioNet數(shù)據(jù)庫的PRCP子數(shù)據(jù)庫(n=10)作為RRI-SBP聯(lián)合分析的數(shù)據(jù)源。從動態(tài)和穩(wěn)態(tài)兩個視角,研究直立傾斜(HUT)引起體位改變前后,以及不同速度改變體位之后,RRI與SBP間耦合性的變化。慢速體位變化(ST)和快速體位(RT)變化分別為在50和2 s之間從水平仰臥升至75°傾斜。提取逐拍RRI和SBP數(shù)據(jù)后,運(yùn)用交叉時頻分析和信息分解方法,結(jié)合時域和短時分形指數(shù)(α1),進(jìn)行RRI和SBP時間序列的聯(lián)合分析。選用THEW數(shù)據(jù)庫中的Normal子數(shù)據(jù)庫和ESRD子數(shù)據(jù)分別作為RRI-QTI聯(lián)合分析的對照組(n=189)和病理實(shí)驗(yàn)組(n=43)數(shù)據(jù)源。采用基于自回歸(AR)模型的短時因果交叉譜方法,通過分析從RRI到QTI(RRI→QTI)方向的線性耦合,探討在生理和病理?xiàng)l件下,基于晝夜節(jié)律的自主神經(jīng)行為刻畫方法。結(jié)果:針對RRI-SBP分析,信息分解分析結(jié)果表明,所有的顯著差異集中在壓力反射導(dǎo)致心率變化de后向反饋回路(SBP→RRI),ST后心率的可預(yù)測性較平臥時顯著增高(0.416±0.067vs0.626±0.127),壓力反射支路的SBP-RRI耦合性升高。而在RRI→SBP方向,HUT對其幾乎沒有影響。ST和RT之前,所有的同類指標(biāo)相比均無顯著差異。ST和RT之后的穩(wěn)態(tài),雖然RRI無顯著差異,但較之ST之后,RT之后RRI 的變異系數(shù)顯著升高(0.054±0.014 vs 0.074±0.027),α1 顯著降低(1.45±0.25 vs 1.28±0.27)。同時,交叉時頻分析結(jié)果揭示了 ST和RT過程中自主神經(jīng)不同的動態(tài)反應(yīng)行為。研究證明了信息分解方法的有效性,可明確區(qū)分心率與血壓相互作用時的前向反饋和后向反饋的主導(dǎo)因果方向,而且可反映HUT前后信號可預(yù)測性的變化。針對RRI-QTI分析,因果交叉譜結(jié)果表明,Normal組的低頻和高頻段的傳遞函數(shù)增益(GLF、GHF)以及LF/HF的晝夜結(jié)果之間存在顯著性差異,而相應(yīng)指標(biāo)在ESRD組中均無晝夜差異;Normal組的晝夜指標(biāo)之比GLF-d/GLF-n以及(LF/HF)d/(LF/HF)n指標(biāo)均顯著大于ESRD組的結(jié)果,而GHF-d/GHF-n則無統(tǒng)計(jì)學(xué)差異。研究結(jié)果提示,相較于正常人(Normal組),ESRD組出現(xiàn)晝夜節(jié)律的消失意味著夜間交感神經(jīng)異常活躍的病理現(xiàn)象。結(jié)論:本課題從RRI-SBP以及RRI-QTI的短時聯(lián)合分析兩個方面,結(jié)合時域和頻域分析以及線性和非線性分析,探索基于動態(tài)心電圖間期時間序列和逐拍血壓序列的心臟自主神經(jīng)行為的評估方法,為臨床應(yīng)用心臟自主神經(jīng)狀態(tài)評估心臟安全提供可靠依據(jù)。
[Abstract]:Background: the autonomic nervous system (ANS) plays an important role in regulation of.ANS may cause the cardiovascular function damage in cardiovascular physiology, cause a variety of cardiovascular disease development. The regulation of blood pressure and ECG signal interval signal artery is regulated by the autonomic nervous system, showing the dynamic characteristics, such as heart rate variability (HRV) and blood pressure variability (BPV). The dynamic interaction of these cardiovascular physiological signal contains important information in autonomic regulation. This study intends to continuous ECG interval and systolic blood pressure (SBP) sequence based, respectively RR interval (RRI) and SBP, RRI and QT interval (QTI) combined with the analysis of the short-term. Characterized by RRI-SBP and RRI-QTI causal interactions, noninvasive evaluation methods of autonomic nervous state. Methods: the PhysioNet database PRCP database (n=10) as RRI-SBP joint Analysis of the data source. From the two aspects of dynamic and static, tilt (HUT) cause postural changes, and different speed changing positions, coupling changes between SBP and RRI. The slow postural changes (ST) and fast position (RT) changes were between 50 and 2 s from the level of supine rose to 75 degrees tilt. The extraction of beat to beat RRI and SBP data, using frequency analysis and cross information decomposition method, combining time-domain and short-time fractal index (alpha 1), combined with analysis of RRI and SBP time series. The THEW database Normal database and ESRD data respectively as the control group combined analysis of RRI-QTI the experimental group (n=189) and pathology (n=43) data source. Based on the autoregressive (AR) short-term causal model of cross spectrum method, through analysis from RRI to QTI (RRI, QTI) linear coupling direction, in physiological and pathological conditions, circadian rhythm based on self The main method to characterize the behavior of nerve. Results: according to RRI-SBP analysis, information decomposition analysis results show that the concentration difference of all lead to changes in the de heart rate baroreflex to feedback loop (SBP, RRI), ST heart rate predictability is recumbent significantly higher (0.416 + 0.067vs0.626 + 0.127), SBP-RRI coupling pressure the reflection branch in RRI and SBP increased. The direction of HUT have little effect on the.ST and RT before the steady state similar indicators all showed no significant difference between.ST and RT, while RRI had no significant difference, but compared to ST, after RT, the coefficient of variation of RRI was significantly increased (0.054 + 0.014 vs 0.074 + 0.027), alpha 1 was significantly decreased (1.45 + 0.25 vs 1.28 + 0.27). At the same time, cross time-frequency analysis results reveal the dynamic response behavior of autonomic nerve of different ST and RT process. The research proves the validity of information decomposition method, can be clearly distinguished Feed forward and backward direction leading causal feedback of heart rate and blood pressure during the interaction, but also can reflect the HUT signal before and after changes in predictability. According to RRI-QTI analysis, causal cross spectrum results show that the transfer function gain Normal group of low and high frequencies (GLF, GHF) there are significant differences between LF/HF and the circadian results in the ESRD group and the corresponding index showed no difference between day and night; day and night index in the Normal group the ratio of GLF-d/GLF-n (LF/HF) and d/ (LF/HF) n index were significantly greater than group ESRD results, but there were no significant differences in GHF-d/GHF-n. The results of the study suggest that, compared to the normal group (Normal group), ESRD the emergence of circadian rhythm disappearance means pathological phenomenon of abnormal sympathetic activity at night. Conclusion: the combined analysis from two aspects of RRI-SBP and RRI-QTI combined with short time domain and frequency domain analysis and linear and nonlinear analysis To explore the evaluation method of cardiac autonomic behavior based on dynamic electrocardiogram interval time series and beat to beat blood pressure sequence, so as to provide reliable evidence for clinical application of cardiac autonomic nervous system to evaluate cardiac safety.

【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R540.41

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