中文摘要

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1 The Nonlinear Analysis of Heart Rate Variability

2 ii

3 i

4 5 (Approxiate Entropy, ApEn) ApEn ApEn ApEn ApEn ApEn ii

5 Abstract Chinese edicine induces several kinds of Chinese edical constitution. The physical reactivity is often the change of bowels, endocrine and physical action. These changes see as close as the regulation of the autonoic nervous syste (ANS). In order to discuss the relation between the ANS and the Chinese edical constitution, the analysis of heart rate variability was applied to assess the yin-yang constitution in Chinese edicine. Six groups of subjects including noral, yin-yang exhaustion, yin exhaustion, yin repletion, yang exhaustion and yang repletion were recruited fro the internal departent of Chinese edicine at China Medical College Hospital. ECG signals were acquired fro all subjects for period of approxiately five inutes in the supine position. In this study, the nonlinear Approxiate Entropy (ApEn) analysis ethod that can quantify the coplexity of ECG signal efficiently was adopted. We expect to exhibit connection between autonoic nervous activity and the coplexity of ECG. The results can offer efficient paraeters for clinical diagnosis. Results showed in nonlinear analysis that the Approxiate Entropy was significantly different fro yin-exhaustion groups, yin-repletion groups and yang-exhaustion groups to the norals. The ApEn values in the yin-exhaustion groups were close to those in the yang-repletion groups, and the value in the yin-repletion groups were close to those in the yang-exhaustion groups. There exists significantly different fro the yin-exhaustion and yang-repletion groups to the yin-repletion and yang-exhaustion groups. According to the Chinese edicine, the yang and yin should be balance to healthy persons, and the yang-repletion will cause the yin exhaustion. Fro the result above, the ApEn value can be used to distinguish the yin-yang constitution Keywords Autonoic nervous syste heart rate variability yin-yang constitution Approxiate Entropy (ApEn) iii

In order to discuss the relation between the ANS and the Chinese edical constitution, the analysis of heart rate variability was applied to assess the yin-yang constitution in Chinese edicine.

6 ...i... ii Abstract... iii... iv... vi... vii r N (ApEn) iv

.. 6 2-4... 7 2-5... 10... 15 3-1... 15 3-2... 17 3-2.

7 v

8 [12] [13] [3] APEN HRV SDNN RMSSD APEN...28 vi

2...24 4.3...24 4.4...25 4.5 HRV...27 4.6 SDNN.

9 2.1 [1] HRV HRV T-TSET SDNN T-TEST RMSSD T-TEST SDNN T-TEST...29 vii

10 1-1 [1] [2] [3] ApEn 1

11 1-2 [3] Heart Rate SDNN [4] (Irregularity) Lyapunov exponent Correlation diension 1991 Pincus ApEn(Approxiate Entropy)[5] [6] ApEn [7] [8] EEG(Electroencephalogra)[9] [10] 2

12 2-1 10~15 5 LabVIEW (FCP-2201, FUKUDA DENSHI) National Instruents DAQPad [11] FUKUDA (ECG) 2.1 3

13 2-2 (1) (Central nervous syste, CNS) (2) (Peripheral nervous, PNS) (Efferent) (Afferent division) ( ) (Soatic nervous syste) (Autonoic nervous syste) (Autonoic ganglion) (Preganlionic fibers) (Postganglionic fibers) (Sypathetic) (Parasypathetic) 2.2 (Thoracolubar) (Craniosacral) 4

14 2.2 [12] (Sypathetic trunks) T1 L3 5

15 (Dual innervations), 2-3 (Partial pericardiu) (Pericardial sac) (Myocardiu) (Endocadiu) (Atriu) (Ventricle) 2.3 (Tricuspid) (Bicuspid) (Seilunar valve) 6

16 (Pulonary seilunar valve) 2.3 [13] (1) (2) (Stroke volue, SV) : = 2-4 (Sinoatrial SA Node) (Bundle of His) (Atrioventricular AV node) (Bundle branches) (Purkinje fibers) 2.4 7

17 c/sec, 45 c/sec [14], 110sec ;, 200 c/sec ~400 c/sec 60 s (Electrocardiography, ECG) ECG 2.5 ECG P QRS QRS coplex P 0.15 QRS 8

18 QRS S QRS T QRS 2.5 9

19 2-5 爲爲爲爲爲 [2] 10

20 爲爲爲爲 ( ) ( ) 1 爲 11

21 2 爲爲爲爲爲 " " 3 " " " 4 " " 爲 2.6 ( ) 12

22 (a) (b) (c) (d) (e) 2.6 [3] (f)

23 [1] 14

24 第三章研究方法本研究中線性分析方面主要包括心率變異分析 Heart Rate Variability, HRV 正常心跳間的標準差 SDNN 與相鄰 NN 區間之間差異值平方和的平均值的平方根(RMSSD) 非線性分析方面選用近似熵 (Approxiate Entropy, ApEn) 為評估的指標以下分別就其方法與內容作介紹 3-1 心率變異分析在 HRV 時域分析主要的計算參數為 5 分鐘心率變異平均值與標準差由統計的方法可計算出線性的分析是將連續心電圖中的每一 QRS 複合波之間隔被偵測出相鄰的 R 波代表著心跳之週期此時間軸間距即為 R-R Interval 而由連續的 R-R Interval 所構成的 Interval series 則代表著心率變異數 Heart Rate Variability, HRV 定義為 Noral-to-Noral (NN) interval 區間相關參數如圖 3.1 所示本研究即是以這心率變異數信號進行線性以及非線性的分析圖 3.1 心電圖與其相關參數 15

25 3.1 SDANN 24 5 HRV SDNN RMSSD pnn50 NN HRV Variable Units Description SDNN s NN SDANN s 5 NN RMSSD s NN SDNN index s NN 5 NN50 count s NN 50 s pnn50 % NN NN50 16

26 3-2 (Approxiate entropy, ApEn) Pincus 1991 [5] ( 100 ) 爲産 -- (1) (2) (3) (4), r r N ( < x n) >= x(1), x(2),..., x( N) r ApEn(,r) N ApEn(,r,N) 1. < x( n) >= x(1), x(2),..., x( N) N ApEn r threshold, r 2. X ( i) = [ x( i), x( i + 1),..., x( i + + 1)], i = 1, N dxi [ ( ), X( j)] X i X j d [ X ( i), X ( j)] = ax [ x( i + k) x( j + k) ] k = 0, 1 Let N () i = no. of d[ X (), i X ( j)] r, C () i r 17

27 C () i = N ()/( i N -+ 1) 3 4 X i r r 4. (r) N 1 1 φ (r)= + ln Cr ( i) N + 1 i= ApEn(, r, N) = φ ( r) φ 1 ( r) ApEn r =2 Pincus =2 r N 1 1 r = ( 0.1 ~ 0.25) SDx, SD x x( n) N 1 n 1 N N = n= 1 x( n) 6. ApEn ApEn Moving Window ApEn Moving Window ApEn 200 Moving Window ApEn 2 18

28 1 ) ( ) ( 1, ), ( 1) 1, (... 1) 1, ( ), ( ), ( + = = = i N i thenn j i ifc j i s j i s j i s j i C r r ), ( ), ( ), ( 1 j i s j i C j i C r r + + = + 1 ) ( ) ( 1, ) ( = = i N i thenn j i ifc r ) /( ) ( ) ( 1) /( ) ( ) ( 1 1 N i N i C N i N i C r r = + =

29 N (r) ln C r ( i) N (r) N i= 1 N i= 1 ln + 1 C r ( i ) ApEn(, r)= (r) APEN 2 3 産 ApEn 3,r N =2 =1 >2 爲 (1) >2 N 爲 N 5000 (2) N >2 r 20

30 =2[9] ApEn(,r) r 爲 ApEn(,r,N) r r Pincus r SD x ( SD x 爲 x(i) ) [9] r=0.1sd x r=0.15sd x r=0.16sd x r=0.2sd x r=0.16sd x N Pincus 爲 ApEn 僞 N= N=200 N=1000 ApEn N= (ApEn) (1) ApEn 麽 +1 ApEn (2) 0 1 産 1 log 0 麽 ApEn 爲産 0 =2 =3 log 産 21

31 ApEn ( ApEn ) ( ApEn ) (3) 2 3 産 (4) 22

32 4-1 LabVIEW [15] ApEn 4.1 ApEn ApEn HRV RMSSD SDNN

33 4.2 r SD x X Y i i

34 Excel Yang[9]

35 4-2 t-test HRV SDNN RMSSD ApEn p (HRV) 4.3 (SDNN) 4.4 RMSSD 4.5 ApEn RMSSD HRV (sec) SDNN ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±

36 4.2 ApEn 0.782± ± ± ± ± ± HRV, HRV 4.5 HRV 70 SDNN , SDNN 4.6 SDNN 27

37 RMSSD, RMSSD 4.7 RMSSD 0.90 ApEn , ApEn 4.8 APEN HRV * 4.3 HRV T-TSET * * * * * * p<

38 SDNN * 4.4 SDNN T-TEST * E-5* * * * 1.16E-6* * * p<0.05 RMSSD * 4.5 RMSSD T-TEST * * 8.3E-06* * * * * E E-6* * * p<0.05 ApEn SDNN T-TEST * * * * * * 8.95E-7* * * * p<

39 4-3 爲 HRV SDNN [4] ApEn ApEn 0.75 ApEn 4.2 ApEn ApEn ApEn 30

40 [1] 1996 [2] 1999 [3] 1996 [4] 2000 [5] S. M. Pincus, Approxiate Entropy: A Coplexity Measure For Biological Tie Series Data, Bioengineering Conference, 1991, Proceedings of the 1991 IEEE Seventeenth Annual Northeast, pp , [6] M. Akay, Nonlinear Bioedical Signal Processing-Dynaic Analysis and Processing, Institute of Electrical and Electronics Engineers, Inc.3Park Avenue, 17 Floor, New York, NY , [7] S. C. Schuckers and P. Raphisak, Distinction of Arrhythias with the Use of Approxiate Entropy, Coputers in Cardiology, pp , 1999 [8] S. C. Schuckers, Approxiate Entropy as a Measure of Morphologic Variability for Ventricular Tachycardia and Fibrillation, Coputers in Cardiology, pp , [9] Y. Fusheng, H. Bo, T. Qingyu, and T.C. Chen, Approxiate Entropy and Its Preliinary Application In The Field of EEG And Cognition, Engineering in Medicine and Biology Society, Proceedings of the 20th Annual International Conference of the IEEE, pp , vol.4, [10] L. Quanzheng and G. Xiaorong, Subsection Approxiate Entropy and Its Application in sleep staging, Engineering in Medicine and Biology, st Annual Conference and the 1999 Annual Fall Meeting of the Bioedical 31

41 Engineering Society] BMES/EMBS Conference, Proceedings of the First Joint, vol.2, P 900, [11] C. C. Chiu, S. J. Yeh, and R. C. Lin, Data acquisition and validation analysis for Finapres signals, Chinese Journal of Medical and Biological Engineering, 15: 47-58, [12] ( ) 1999 [13] 1998 [14] 1988 [15]

第一章前言

第一章前言 The Implementation of Arrhythmia Analysis System ii LabVIEW So and Chan QRS R-R interval QRS duration Tompkins and Ahlstrom 1983 R-R interval QRS duration search back 1R-R interval 8 R-R interval ± 14