混沌医学、稳态与猝死

Chaotic medicine, homeostasis and sudden death

学术背景:临床研究发现心率变异性与植物性神经系统、亚健康及猝死密切相关,理论医学研究总结了一些混沌医学和稳态相关理论。但至今为止未见将二者结合对临床现象进行系统解释并总结出亚健康的诊断标准和预防猝死的有效指标。目的:用混沌医学和稳态相关理论阐述、植物神经、亚健康及猝死的关系。为实践中应用心率变异性评价亚健康状态和预防猝死提供理论依据。检索策略:由该论文的研究人员应用计算机检索Pubmed数据库1995-01/2007-06的相关文献,检索词为"Chaoticmedicine,heartratevariability(HRV),Suddendeath,Sub-health,homoestasis",限定文章语言种类为English。同时计算机检索博客和中国期刊全文数据库1995-01/2007-06期间的相关文章,检索词为"混沌医学,心率变异性,猝死,亚健康,稳态,"限定文章语言种类为中文。共检索到文献56篇,对资料进行初审,纳入标准:①混沌医学及与心率变异性、猝死、亚健康密切相关。②同一领域选择近期发表或在权威杂志上发表的文章。排除标准:重复性研究。文献评价:选取其中的30篇文献的来源主要是混沌医学,心率变异性,猝死,亚健康,稳态等方面的综述、基础和临床实验研究和相关博客发表在网上的文章。资料综合:①任何一个多细胞、多系统组成的个体,存在着至少三级混沌系统,整体混沌系统、维持血压的心血管混沌系统和细胞混沌系统。健康状态是三级混沌系统均处于正常状态。疾病和亚健康状态是某些细胞或心血管系统代谢障碍,反馈信息传到中枢神经系统,导致中枢神经过度紧张,交感神经过度兴奋,心率变异性下降,导致混沌系统处于亚稳态。②根据混沌医学和稳态理论,个体的混沌运动可能处于4种状态:健康、疾病、亚健康和猝死之前的失稳边缘状态。健康时机体处于稳态,疾病和亚健康时机体处于亚稳态,可能某种因素导致健康状态发展成亚健康和疾病,他们可能互相转化,并且二者都可能因失稳导致猝死。③中枢神经系统极度紧张,交感神经极度兴奋,整体混沌运动处于失稳的边缘,受刺激导致系统迅速失稳,表现为不能维持动脉血压而猝死。结论:长期健康状态无法预测,但可以通过短期心率变异性的测试结果预测一两天的健康状况,通过定期或每天清晨512次心率变异性测试的动态观察,可以判断一个人睡眠之后的健康状态,以及整体健康状态的变化趋势,并推测其处于健康状态、亚健康状态或处于失稳边缘的可能发生猝死状态。

BACKGROUND： Clinical studies have discovered heart rate variability （HRV） is closely correlated with autonomic nervous system, sub-health and sudden death. Medical studies have summarized some chaotic medical science and homeostasis relevance theory. But so far the combination could still not systematically explain the clinical manifestation or summarize the diagnostic standards for sub-health and effective index to prevent sudden death. OBJECTIVE： To elucidate the correlation among autonomic nervous system, sub-health and sudden death by using chaotic medicine and homeostasis, so as to provide theoretical basis for evaluating sub-healthy state using HRV and preventing sudden death HRV. RETRIEVAL STRATEGY： A computer-based online search of Pubmed was undertaken to identify the articles published in English between January 1995 and June 2007 with the keywords of ＂chaotic medicine, heart rate variability （HRV）, Sudden death, Sub-health, homeostasis＂. Meanwhile, the Weblog and CNKI database were searched for relevant articles dated from January 1995 and June 2007 with the same keywords in Chinese. Fifty-six papers were searched. After the first trial, only articles （1）closely correlated with chaotic medical science, sudden death and sub-health, and （2）published recently or in authority magazine in same field were selected. Repetitive studies were excluded. LITERATURE EVALUATION： The review articles, basic and clinical experiments about chaotic medical science, HRV, sudden death, sub-health, and homeostasis as well as articles published in related weblogs were selected. DATA SYNTHESIS： （1）In any individual composed of multi-cells and multi-system, there are at least three-level chaotic system： overall chaotic system, cardiovascular chaotic system maintaining the blood pressure and cell chaotic system. Healthy state is that the three chaotic systems are in normal condition. Disease and sub-healthy state is the sub-stable state of chaotic system caused by the overstress of central nervous system, overexcitation of autonomic nerves and HRV decrease when there is some cell or cardiovascular system malfunction, and the information is feedback to central nervous system. （2）Based on the theory about chaotic medicine and homeostasis, there are four states in individual chaotic motion： health, disease, sub-health, and homeostasis border before sudden death. The health is the homeostasis of body; disease and sub-health are the sub-homeostasis and may develop from healthy state because various factors; they may transform each other and both of them may lead to sudden death for unsteady. （3）The extreme tension of central nervous system and over-excitation of autonomic nerves result in the destabilizing overall chaotic motion. Stimulation induces system destabilizing and sudden death because the patient cannot maintain arterial blood pressure. CONCLUSION： Long-term healthy state is unpredictable, but we can forecast 1-2 days situations by short-term HRV testing for 512 times in the early morning of every day, and judge the healthy state after sleep, and the change tendency of healthy state. Accordingly, we could predict person is in healthy state, sub-healthy state or unsteady border state that could cause sudden death.