压力与健康分析仪推广演讲稿

您有压力吗？Are you under stress?,?,您要知道,70%的内科门诊病人患有压力性疾病 That 70% of out-coming patients in internal medicine are suffering from STRESS DISEASE压力能够损伤您的心脏 That STRESS can STOP your heart,应激物（紧张性刺激物 ）不总是有害的,ANS*,应激物,对处理应激物适当地反应,较健康的心身条件能承受更多的压力,成功地对抗应激物,*ANS (自主神经系统): 是神经系统可支配心血管、消化、生殖和呼吸器官的部份。ANS操纵意识经外调控基本的生命维持功能如心率、消化和呼吸,ANS,慢性，重度应激物,对抗压力失败,引起压力性疾病,但，又可引起严重的问题,改变,ANS,对抗压力慢性失败,严重身/心疾病,微小应激物,如果您有压力，您会有如下的经验,疲倦注意力分散消化不良便秘食欲欠佳过食 (肥胖症)皮肤不适抑郁睡眠困难头痛 (偏头痛)其他,较小的问题,当然，这些小问题也能成为您 的“大问题”，使您的日常生活受到困扰。对您的医生来讲大部分是较小的问题。虽然您的医生也会说：不幸地，您的压力已经引起您的问题。但似乎没有许多事情，您的医生能为您处理您的压力。,当您的压力引起大问题时,免疫力低下慢性疲劳症候群激惹性肠综合征抑郁焦虑性疾病不育症心梗癌症其他,大问题,当您的问题对医生来讲似乎成了“大问题”时，医生们就不是简单地去处理了。最重要的是要处理您的压力。,您自己是个当权（白领阶层）人物吗？ Yourself,is the right person, 您的日常生活，都在高层领域圈子里吗？Your daily lives, are the right places.,为处理您的压力而采取行动！To Take Actions for Managing Your Stress!,检查和评估您的压力！,检查您的日常压力观察帮助处理您的压力.,展示您的身/心压力和压力对抗能力帮助您找到适当的活动缓解您的压力对您的活动客观地显示压力放松的效果,客观的压力检测工具With the objective Stress Checking tool,EART,ARIABILITY,ATE,HRV,HRV（心率变异性）是什么？,如果每一时段的正常范围内您的心率是高度的不规则，就意味着您的HRV（心率变异性）是高的，您的压力对抗能力是好的。,about HRV,有关HRV一般信息General information,I. HRV的概念 Concept of HRV,II. HRV研究历史 History of HRV studies,III.分析的方法学 Methodology of Analysis,HRV的概念Concept of HRV,历史背景,在平稳状态条件下，心率是一成不变地规则。,1929年Walter B.cannon“内环境稳定”生理学： 所有细胞、组织和器官维持在一种内环境状态或”稳定的状态”条件。,旧概念,在”稳定状态”的条件下，其生物学过程以复杂和非线性方式而改变。,新概念,正常休息时心脏的窦性节律是高度不规则的。,在连续的时间来自生理过程，,如：心率、血压、神经活动的一系列资料。,845 - 1049 - 911 - 1023 (msec),注意：R-R波两者之间的间隔时间是连续地变化的。 Note that the time (ms) between R-R intervals is continuously changing .,What is HRV ?,心电图信号ECG Signal,R R,R R,HRV是心跳与心跳两者之间间隔的长度波动的程度。HRV,Heart Rate Variability isThe degree of fluctuation in the length of the intervals between heart beats ( Malik & Camm, 1995),HRV的产生,100-120 beats/min,情绪影响体温调节体位、照明呼吸率及其它,自主神经系统疾病心血管病、神经病压力/年老其它,内环境失平衡,心脏的固有节律 (SA结节）,心率的波动,HRV的产生,减低心率的动力学复杂性 Reduced dynamic complexity of heart rate 降低自主神经系统活性 Lowered ANS Activity 降低对外连续性改变环境所需的能力 Decreased ability to cope with the requirements of the continuously changing environment 容易破坏内环境稳定性 Easily breakable homeostasis,抑郁性HRV的意义 Meaning of Depressed HRV,抑郁的HRV指征 Depressed HRV indicates ,引起 Reflects,反射 Causes,换言之 In other words,HRV研究史History of HRV studies,1965年Hon和Lee注意到在胎心窘迫发生之前最初的改变是心跳与心跳间隔的变化。HR变化之前R-R变化。 1965 Hon & Lee noticed that the beat to beat interval changes are the first alteration before fetal distress occurs. R-R change precedes HR change.1971年Sayers与其他人注意到心跳对心跳HR的节律体现。 1971 Sayers and others focused on rhythm imbedded in beat-to-beat HR.1977年Wolf等指出，HRV与MI突然死亡发生有关。 1977 Wolf et al showed association of HRV to sudden death post MI.1981年介绍了能量光谱分析。（PSD） 1981 Akselrod introduced Power Spectral Analysis (PSD).1980年后期证实HRV是急性MI后死亡的指征。 Late 1980s HRV confirmed strong predictor of mortality after an acute MI.1996年循环杂志出版了对HRV测定的标准。 1996 Task Force publish Standards of Measurement for HRV Circulation 1996.,HRV研究史 History of HRV studies,HRV研究史 History of HRV studies,爱滋病酒精中毒麻醉神经性厌食哮喘自主神经系统脑死亡心脏学吸烟激惹性肠综合症偏头痛肥胖担扰,强迫症恐慌症帕金森病外伤后压力症侯群精神分裂症脓毒病结肠镜检查抑郁糖尿病透析雌激素替代担扰,纤维肌痛心、情绪、身体联系高血压高热睡眠呼吸暂停失眠脊髓损伤运动科学中风突发性心性死亡突发性婴儿死亡昏厥,HRV研究史,分析方法 Methodology of Analyze,时间Timesec,时间域分析Time domain analysis,Frequency domain,HRV分析时间域与频率域 HRV analysis - Time and Frequency domain,频率域分析Frequency domain analysis,LF,HF,VLF,FFT快速修复转换技术 (Fast Furrier Transform) technique,心率组方图Tachogram of heart rate,低频率波Only Low frequency (LF) wave(by filtering high frequency band),高频率波Only High frequency (HF) wave (by filtering low frequency band),如何分析频率域 How to analyze the frequency domain?,HRV分析时间与频率域 HRV analysis - Time and Frequency domain,交感神经系统Sympathetic Nerve System (SNS),副交感神经系统Parasympathetic Nerve System(PNS),有关幅度,自主神经系统分析仪SA-3000P ANS Analyzer,自主神经系统AutonomicNervousSystem,内部不平衡InternalImbalance,固有心脏节律CardiacInherent Rhythm(SA node),心率的波动FluctuationofHeart Rate,情绪影响、体热调节、体位、照明Emotional EffectThermo-regulationBody Posture(BP)Illumination,自主神经系疾病心血管病/神经病 压力/老化ANS DisorderCardiovascular DiseasesNeuropathyStress / Aging,HRV被自主神经调节的机理 Mechanism of HRV by ANS control,HRV的分析 Analysis of HRV,时间域分析Time Domain Analysis,频率域分析Frequency Domain Analysis,SA-3000P软件是对心率变异性短时评估的标准和数字程序而开发的。“The SA-3000P software was developed to meet the standards and mathematical procedures for the short term HRV evaluation.”,心率变异分析仪的介绍 Introduction of HRV analyzer,标准和数学程序（1996Standards and mathematical procedures(1996)欧洲心脏病协会和北美电子生理协会By The European Society of Cardiology& The North American Society of Pacing and Electrophysiology,1993 Sep;88(3):927-34 The ability of several Short-term measures of RR variability to predict mortality after myocardial infarction ; Bigger, Fleiss, Rolnitzky, Steinman,长时间和短时间测量心率变异性在715例病人比较、研究结论指出从短ECG记录计算出RRV变异性的能量光谱测定与24小时者比较明显地相似。“Short and long term HRV testing was compared in a study of 715 patients and they concluded that Power spectral measures of RR variability calculated from short ECG recordings are remarkably similar to those calculated over 24hours.”,记录时间 Recording Time,长期和短期测量两者间的相互关系: Correlation between long term and short term measurement,测量时注意事项 Cautions for measurement,-受检者应先适应检查室环境 Time to adjust the new environment is needed. -测量时勿动与讲话 Please dont move or talk during measurement.-保持恒定的测量时间(早/晚) Please try to keep the measurement time (morning/evening) -适宜的测量环境(勿太亮或太暗) The appropriate environment: Avoid too bright light or noise -呼吸应在平常或休息状态 Respiration: In normal and resting state-测量前最少2小时内避免喝咖啡 Avoid caffeine at least 2 hours before the measurement -避免饭后2小时内测量 Avoid the measurement right after the meal(2 hours after the meal),频率域分析 Frequency domain analysis,LF/HF比例、LF和HF的正常值自主神经系统平衡：LF/HF（休息位：0.52.0)-自主神经系统不平衡： 交感主导、副交感主导 -急性压力反应：自主神经系 统失平衡和SNS升高-慢性压力反应：自主神经系统的 复杂状态LF/HF ratio, Normalized LF & HF ANS Balance : LF/HF ratio (in resting position) : 0.5-2.0 ANS Imbalance SNS Dominant PNS Dominant - Acute stress reaction : ANS imbalance with SNS arousal - Chronic stress reaction : Complex phase of ANS mechanism,-、-,自主神经系统(ANS)的平衡Balance of Autonomic nervous system,平衡好 Good Balance,交感神经主导SNS dominant,副交感神经主导PNS dominant,SNS : PNS = 6 : 4,张力亢进：僬虑、 恐慌 、PTSDHypertonia ：AnxietyPanic 、 PTSD,张力减退：慢性压抑女男Hypotonia：chronic DepressionWomen Men,* LF/HF的绝对值要考虑的 Absolute power of LF and HF have to be considered.,频率域分析 Frequency domain analysis,HRV分析的临床应用 Clinical application of HRV analysis,HRV的主要临床应用 Main Clinical Application of HRV,减少HRV decreased HRV 压力相关疾病 stress related disorders 症状:疲劳 、心悸、焦虑、 抑郁、头晕、精力不足 、头痛、 胃肠障碍、心理疾病 Symptoms : fatigue, palpitation, anxiety, depression, dizziness, anergia, headache, GI disturbances Psychosomatic disorders,Deciding & PredictingTx. Response决定和预测Tx,反应,MI, SCDKaroshi,HRV分析的临床应用Clinical application of HRV analysis,身体/精神压力影响总的健康状态Assess the general health statusInfluenced by Physical/Mental stress,慢性压力引致疾病的早期警讯Early warning of the disorders from chronic stress客观展示病人的压力指数-Show the stress to the patient objectively,评估期Assessing phase,病人的症状的相互关系Correlation with the patients s