心率变异性在针刺研究中的应用
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摘要
心率变异性(HRV)的检测具有无创和操作简便的优点,被广泛应用于临床及科研中,而越来越多的针刺研究也将HRV作为重要的观察指标。本文在介绍HRV的定义、由来、分析方法及各项参数意义的基础上,回顾并分析了近年来HRV在针刺研究中的应用现状,主要从针刺与假针刺、不同的针刺方法、针刺不同的穴位等方面分析了对HRV的影响,肯定了HRV在反映针刺效应中的作用。但是,由于HRV检测干扰因素较多及数据分析方法多样,导致对HRV的实验结果报道差异比较大,对参数的解读也存在明显的分歧。因此,在今后以HRV为观察指标的针刺研究中需谨慎分析处理。
The measurement of heart rate variability(HRV)has the advantages of noninvasiveness and simple operation and is widely used in clinical trials and scientific research for assessing reactions of the autonomic nervous system.More and more studies on acupuncture also take HRV as an important index.In addition to the definition,origin,analytical methods,and significance of time domain and frequency domain parameters of HRV,we reviewed the situations of application of HRV to acupuncture research in recent years,analyzed the influence of acupuncture and sham acupuncture,different acupuncture methods,and different acupoints on HRV,and confirmed the role of HRV in reflecting the effect of acupuncture on the vagal and sympathetic systems.However,various interference factors for HRV measurement and diverse methods for data analysis may lead to great differences in the experimental results of HRV and the interpretation of parameters.Therefore,careful analysis is needed in future studies on acupuncture with HRV as an observation index.
The measurement of heart rate variability(HRV)has the advantages of noninvasiveness and simple operation and is widely used in clinical trials and scientific research for assessing reactions of the autonomic nervous system.More and more studies on acupuncture also take HRV as an important index.In addition to the definition,origin,analytical methods,and significance of time domain and frequency domain parameters of HRV,we reviewed the situations of application of HRV to acupuncture research in recent years,analyzed the influence of acupuncture and sham acupuncture,different acupuncture methods,and different acupoints on HRV,and confirmed the role of HRV in reflecting the effect of acupuncture on the vagal and sympathetic systems.However,various interference factors for HRV measurement and diverse methods for data analysis may lead to great differences in the experimental results of HRV and the interpretation of parameters.Therefore,careful analysis is needed in future studies on acupuncture with HRV as an observation index.
引文
[1]吴逸南,葛志明,李方,等.慢性心力衰竭与心脏自主神经功能异常的关系:附66例分析[J].新医学,2006,37(1):30-32.
[2] HON E H.Fetal heart rate monitoring[J].Biomed Sci Instrum,1963,1:287-291.
[3] HON E H,LEE S T.Electronic evaluation of the fetal heart rate.Ⅷ.Patterns preceding fetal death,further observations[J].Am J Obstet Gynecol,1963,87:814-826.
[4] AKSELROD S,GORDON D,UBEL F A,et al.Power spectrum analysis of heart rate fluctuation:aquantitative probe of beat-to-beat cardiovascular control[J].Science,1981,213(4504):220-222.
[5] Heart rate variability:standards of measurement,physiological interpretation and clinical use.task force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology[J].Circulation,1996,93(5):1043-1065.
[6] SACHA J.Interaction between heart rate and heart rate variability[J].Ann Noninvasive Electrocardiol,2014,19(3):207-216.
[7] KAMATH M,WATANABE M,UPTON A.Heart Rate Variability(HRV)signal analysis[M].Boca Raton:CRC Press,2012.
[8]洪必莹,何森,陈晓平.心率变异性研究进展[J].华西医学,2013,28(4):614-618.
[9] COENEN A J,KITNEY R I,ROMPELMAN O.Thermally elicited entertainment of heart rate variability(proceedings)[J].J Physiol(Lond),1977,270(1):5-6.
[10] KITNEY R I,ROMPELMAN O.Thermal entrainment patterns in heart rate variability(proceedings)[J].J Physiol(Lond),1977,270(1):41-42.
[11] PONIKOWSKI P,CHUA T P,PIEPOLI M,et al.Chemoreceptor dependence of very low frequency rhythms in advanced chronic heart failure[J].Am J Physiol,1997,272(1Pt 2):H438-H447.
[12] LANFRANCHI P A,SOMERS V K.Arterial baroreflex function and cardiovascular variability:interactions and implications[J].Am J Physiol Regul Integr Comp Physiol,2002,283(4):R815-R826.
[13] MALPAS S C.Neural influences on cardiovascular variability:possibilities and pitfalls[J].Am J Physiol Heart Circ Physiol,2002,282(1):H6-H20.
[14] BERNTSON G G,BIGGER J T Jr,ECKBERG D L,et al.Heart rate variability:origins,methods,and interpretive caveats[J].Psychophysiology,1997,34(6):623-648.
[15] CERUTTI C,BARRES C,PAULTRE C.Baroreflex modulation of blood pressure and heart rate variabilities in rats:assessment by spectral analysis[J].Am J Physiol,1994,266(5Pt 2):H1993-H2000.
[16] FURLAN R,PORTA A,COSTA F,et al.Oscillatory patterns in sympathetic neural discharge and cardiovascular variables during orthostatic stimulus[J].Circulation,2000,101(8):886-892.
[17] PAGANI M,MONTANO N,PORTA A,et al.Relationship between spectral components of cardiovascular variabilities and direct measures of muscle sympathetic nerve activity in humans[J].Circulation,1997,95(6):1441-1448.
[18] MALLIANI A,PAGANI M,LOMBARDI F,et al.Cardiovascular neural regulation explored in the frequency domain[J].Circulation,1991,84(2):482-492.
[19] CHUNG J W,YAN V C,ZHANG H W.Effect of acupuncture on heart rate variability:a systematic review[J].Evid Based Complement Alternat Med,2014,2014:819871.
[20] ANDERSON B,NIELSEN A,MCKEE D,et al.Acupuncture and heart rate variability:a systems level approach to understanding mechanism[J].Explore(NY),2012,8(2):99-106.
[21] HUANG S T,CHEN G Y,LO H M,et al.Increase in the vagal modulation by acupuncture at Neiguan point in the healthy subjects[J].Am J Chin Med,2005,33(1):157-164.
[22] KIM E,CHO J H,JUNG W S,et al.Effect of acupuncture on heart rate variability in primary dysmenorrheic women[J].Am J Chin Med,2011,39(2):243-249.
[23]林仁勇,吴俊贤,张佩,等.神门穴真、假针刺对心率和心率变异性影响的比较研究[J].时珍国医国药,2012,23(3):752-754.
[24] B?CKER M,GROSSMAN P,SCHNEIDER J,et al.Acupuncture in migraine:investigation of autonomic effects[J].Clin J Pain,2008,24(2):106-115.
[25] LEE S,LEE M S,CHOI J Y,et al.Acupuncture and heart rate variability:a systematic review[J].Auton Neurosci,2010,155(1-2):5-13.
[26] LEE N R,KIM S B,HEO H,et al.Comparison of the effects of manual acupuncture,laser acupuncture,and electromagnetic field stimulation at acupuncture point BL15on heart rate variability[J].J Acupunct Meridian Stud,2016,9(5):257-263.
[27] LITSCHER G.Transcontinental and translational high-tech acupuncture research using computer-based heart rate and“Fire of Life”heart rate variability analysis[J].J Acupunct Meridian Stud,2010,3(3):156-164.
[28]罗丽平,沈仲元,陈汉平,等.针刺内关-间使对健康人心脏自主神经的调节作用[J].上海针灸杂志,2009,28(10):603-606.
[29] ZHOU W Y,TJEN-A-LOOI S C,LONGHURST J C.Brain stem mechanisms underlying acupuncture modality-related modulation of cardiovascular responses in rats[J].J Appl Physiol,2005,99(3):851-860.
[30] KURONO Y,MINAGAWA M,ISHIGAMI T,et al.Acupuncture to Danzhong but not to Zhongting increases the cardiac vagal component of heart rate variability[J].Auton Neurosci,2011,161(1-2):116-120.
[31]陈远源.针灸合谷或内关对健康人自主神经活动的影响[D].广州:南方医科大学,2016.
[32]徐敏.针刺灵台、神道穴对糖尿病心脏自主神经病变患者HRV的影响[D].济南:山东中医药大学,2017.
[33] YANG Z K,WU M L,XIN J J,et al.Manual acupuncture and laser acupuncture for autonomic regulations in rats:observation on heart rate variability and gastric motility[J].Evid Based Complement Alternat Med,2013,2013:276320.
[34]崔明亮,李国强,王景贵,等.交感型颈椎病对心率变异性频谱的影响[J].武警医学院学报,2008,17(2):92-95.
[35] AGELINK M W,SANNER D,EICH H,et al.Does acupuncture influence the cardiac autonomic nervous system in patients with minor depression or anxiety disorders[J].Fortschr Neurol Psychiatr,2003,71(3):141-149.
[36] HAKER E,EGEKVIST H,BJERRING P.Effect of sensory stimulation(acupuncture)on sympathetic and parasympathetic activities in healthy subjects[J].J Auton Nerv Syst,2000,79(1):52-59.
[37]石现,杜怀东,花丽艳.针刺对家犬实验性心率变异性改变的影响[J].大连医科大学学报,1999,21(1):15-16.
[38]张志雄,包怡敏,郁礼兴,等.迷走神经在电针提高急性心肌缺血早期室颤阈中的作用[J].上海针灸杂志,2000,19(5):36-38.
[39] WANG H,LITSCHER G,SHI X,et al.Effects of acupuncture on heart rate variability in beagles:preliminary results[J].Evid Based Complement Alternat Med,2013,2013:419212.
[40] DUSCHEK S,MUCKENTHALER M,WERNER N,et al.Relationships between features of autonomic cardiovascular control and cognitive performance[J].Biol Psychol,2009,81(2):110-117.
[41] DUSCHEK S,HEISS H,BUECHNER B,et al.Hemodynamic determinants of chronic hypotension and their modification through vasopressor application[J].J Physiol Sci,2009,59(2):105-112.
[42] REYES DEL PASO G A,LANGEWITZ W,MULDER L J,et al.The utility of low frequency heart rate variability as an index of sympathetic cardiac tone:a review with emphasis on a reanalysis of previous studies[J].Psychophysiology,2013,50(5):477-487.
[2] HON E H.Fetal heart rate monitoring[J].Biomed Sci Instrum,1963,1:287-291.
[3] HON E H,LEE S T.Electronic evaluation of the fetal heart rate.Ⅷ.Patterns preceding fetal death,further observations[J].Am J Obstet Gynecol,1963,87:814-826.
[4] AKSELROD S,GORDON D,UBEL F A,et al.Power spectrum analysis of heart rate fluctuation:aquantitative probe of beat-to-beat cardiovascular control[J].Science,1981,213(4504):220-222.
[5] Heart rate variability:standards of measurement,physiological interpretation and clinical use.task force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology[J].Circulation,1996,93(5):1043-1065.
[6] SACHA J.Interaction between heart rate and heart rate variability[J].Ann Noninvasive Electrocardiol,2014,19(3):207-216.
[7] KAMATH M,WATANABE M,UPTON A.Heart Rate Variability(HRV)signal analysis[M].Boca Raton:CRC Press,2012.
[8]洪必莹,何森,陈晓平.心率变异性研究进展[J].华西医学,2013,28(4):614-618.
[9] COENEN A J,KITNEY R I,ROMPELMAN O.Thermally elicited entertainment of heart rate variability(proceedings)[J].J Physiol(Lond),1977,270(1):5-6.
[10] KITNEY R I,ROMPELMAN O.Thermal entrainment patterns in heart rate variability(proceedings)[J].J Physiol(Lond),1977,270(1):41-42.
[11] PONIKOWSKI P,CHUA T P,PIEPOLI M,et al.Chemoreceptor dependence of very low frequency rhythms in advanced chronic heart failure[J].Am J Physiol,1997,272(1Pt 2):H438-H447.
[12] LANFRANCHI P A,SOMERS V K.Arterial baroreflex function and cardiovascular variability:interactions and implications[J].Am J Physiol Regul Integr Comp Physiol,2002,283(4):R815-R826.
[13] MALPAS S C.Neural influences on cardiovascular variability:possibilities and pitfalls[J].Am J Physiol Heart Circ Physiol,2002,282(1):H6-H20.
[14] BERNTSON G G,BIGGER J T Jr,ECKBERG D L,et al.Heart rate variability:origins,methods,and interpretive caveats[J].Psychophysiology,1997,34(6):623-648.
[15] CERUTTI C,BARRES C,PAULTRE C.Baroreflex modulation of blood pressure and heart rate variabilities in rats:assessment by spectral analysis[J].Am J Physiol,1994,266(5Pt 2):H1993-H2000.
[16] FURLAN R,PORTA A,COSTA F,et al.Oscillatory patterns in sympathetic neural discharge and cardiovascular variables during orthostatic stimulus[J].Circulation,2000,101(8):886-892.
[17] PAGANI M,MONTANO N,PORTA A,et al.Relationship between spectral components of cardiovascular variabilities and direct measures of muscle sympathetic nerve activity in humans[J].Circulation,1997,95(6):1441-1448.
[18] MALLIANI A,PAGANI M,LOMBARDI F,et al.Cardiovascular neural regulation explored in the frequency domain[J].Circulation,1991,84(2):482-492.
[19] CHUNG J W,YAN V C,ZHANG H W.Effect of acupuncture on heart rate variability:a systematic review[J].Evid Based Complement Alternat Med,2014,2014:819871.
[20] ANDERSON B,NIELSEN A,MCKEE D,et al.Acupuncture and heart rate variability:a systems level approach to understanding mechanism[J].Explore(NY),2012,8(2):99-106.
[21] HUANG S T,CHEN G Y,LO H M,et al.Increase in the vagal modulation by acupuncture at Neiguan point in the healthy subjects[J].Am J Chin Med,2005,33(1):157-164.
[22] KIM E,CHO J H,JUNG W S,et al.Effect of acupuncture on heart rate variability in primary dysmenorrheic women[J].Am J Chin Med,2011,39(2):243-249.
[23]林仁勇,吴俊贤,张佩,等.神门穴真、假针刺对心率和心率变异性影响的比较研究[J].时珍国医国药,2012,23(3):752-754.
[24] B?CKER M,GROSSMAN P,SCHNEIDER J,et al.Acupuncture in migraine:investigation of autonomic effects[J].Clin J Pain,2008,24(2):106-115.
[25] LEE S,LEE M S,CHOI J Y,et al.Acupuncture and heart rate variability:a systematic review[J].Auton Neurosci,2010,155(1-2):5-13.
[26] LEE N R,KIM S B,HEO H,et al.Comparison of the effects of manual acupuncture,laser acupuncture,and electromagnetic field stimulation at acupuncture point BL15on heart rate variability[J].J Acupunct Meridian Stud,2016,9(5):257-263.
[27] LITSCHER G.Transcontinental and translational high-tech acupuncture research using computer-based heart rate and“Fire of Life”heart rate variability analysis[J].J Acupunct Meridian Stud,2010,3(3):156-164.
[28]罗丽平,沈仲元,陈汉平,等.针刺内关-间使对健康人心脏自主神经的调节作用[J].上海针灸杂志,2009,28(10):603-606.
[29] ZHOU W Y,TJEN-A-LOOI S C,LONGHURST J C.Brain stem mechanisms underlying acupuncture modality-related modulation of cardiovascular responses in rats[J].J Appl Physiol,2005,99(3):851-860.
[30] KURONO Y,MINAGAWA M,ISHIGAMI T,et al.Acupuncture to Danzhong but not to Zhongting increases the cardiac vagal component of heart rate variability[J].Auton Neurosci,2011,161(1-2):116-120.
[31]陈远源.针灸合谷或内关对健康人自主神经活动的影响[D].广州:南方医科大学,2016.
[32]徐敏.针刺灵台、神道穴对糖尿病心脏自主神经病变患者HRV的影响[D].济南:山东中医药大学,2017.
[33] YANG Z K,WU M L,XIN J J,et al.Manual acupuncture and laser acupuncture for autonomic regulations in rats:observation on heart rate variability and gastric motility[J].Evid Based Complement Alternat Med,2013,2013:276320.
[34]崔明亮,李国强,王景贵,等.交感型颈椎病对心率变异性频谱的影响[J].武警医学院学报,2008,17(2):92-95.
[35] AGELINK M W,SANNER D,EICH H,et al.Does acupuncture influence the cardiac autonomic nervous system in patients with minor depression or anxiety disorders[J].Fortschr Neurol Psychiatr,2003,71(3):141-149.
[36] HAKER E,EGEKVIST H,BJERRING P.Effect of sensory stimulation(acupuncture)on sympathetic and parasympathetic activities in healthy subjects[J].J Auton Nerv Syst,2000,79(1):52-59.
[37]石现,杜怀东,花丽艳.针刺对家犬实验性心率变异性改变的影响[J].大连医科大学学报,1999,21(1):15-16.
[38]张志雄,包怡敏,郁礼兴,等.迷走神经在电针提高急性心肌缺血早期室颤阈中的作用[J].上海针灸杂志,2000,19(5):36-38.
[39] WANG H,LITSCHER G,SHI X,et al.Effects of acupuncture on heart rate variability in beagles:preliminary results[J].Evid Based Complement Alternat Med,2013,2013:419212.
[40] DUSCHEK S,MUCKENTHALER M,WERNER N,et al.Relationships between features of autonomic cardiovascular control and cognitive performance[J].Biol Psychol,2009,81(2):110-117.
[41] DUSCHEK S,HEISS H,BUECHNER B,et al.Hemodynamic determinants of chronic hypotension and their modification through vasopressor application[J].J Physiol Sci,2009,59(2):105-112.
[42] REYES DEL PASO G A,LANGEWITZ W,MULDER L J,et al.The utility of low frequency heart rate variability as an index of sympathetic cardiac tone:a review with emphasis on a reanalysis of previous studies[J].Psychophysiology,2013,50(5):477-487.