An Implanted Closed-loop Chip System for Heart Rate Control:System Design and Effects in Conscious Rats

Objective： To evaluate the efficiency of an implanted chip system for the control of heart rate （HR）. Methods： The HR was recorded in six conscious Sprague-Dawley （SD） rats. An implanted chip system was designed to regulate the HR by stimulating the right cervical vagus nerve according to the feedback of real time HR. Each rat was subjected to 30-min regulation and 30-min recovery. The change of HR during the regulation period was compared with the control. The ECG was recorded during the experiment for 24 h. Results： The ECG signals were successfully recorded during the experiment. The HR was significantly decreased during the period of regulation compared with control （-79.3 ± 34.5, P 〈 0.01, n = 6） and then recovered to normal after regulation. Conclusion： The described implanted chip system can regulate the HR to a designated set point.

An Intelligent Sensor Based System for Real Time Heart Rate Monitoring (HRM)

A method and apparatus for monitoring heart rate of the heart using a wearable system is designed and implemented in this paper. A heart rate receives from heart beat signals and stores the data to a database and after a time period this method can determine an idle heart rate of the monitoring body. This idle heart rate is compared with the stored data and can determine the normal and abnormal heart rate variability. After the certain time period this system can detect the heart rate and also can send a signal to the user in time of abnormalities. Consequent estimations of heart rate variability are contrasted with this.

A Novel Design of Fuzzy PID Controllers for Dual-Sensor Cardiac Pacemaker Systems

This work proposes to design a fuzzy proportional-integral derivative (FPID) controller for dual-sensor cardiac pacemaker systems, which can automatically control the heart rate to accurately track a desired preset profile. The combination of fuzzy logic and conventional PID control approaches is adopted for the controller design based on dual-sensors. This controller offers good adaptation of the heart rate to the physiological needs of the patient under different states (rest and walk). Through comparing with the conventional fuzzy control algorithm, FPID provides a more suitable control strategy to determine a pacing rate in order to achieve a closer match between actual heart rate and a desired profile. To assist the heartbeat recovery, the stimuli with adjustable pacing rate is generated by the pacemaker according to the FPID controller, such actual heart rate may track the preset heart rate faithfully. Simulation results confirm that this proposed control design is effective for heartbeat recovery and maintenance. This study will be helpful not only for the analysis and treatment of bradycardias but also for improving the performance of medical devices.

Fuzzy Controller for Dual Sensors Cardiac Pacemaker System in Patients with Bradycardias at Rest

Cardiovascular disease is defined as a heart rate that is less than 60 bpm. Implantable cardiac devices such as pacemakers are widely used nowadays. In this paper, design and implementation of the heart model can be controlled to be the heart of a patient suffering from a decrease in heart rate (Bradycardia). A system is designed to sense and calculate the heart rate per minute and it is considered as an input to the controller. The design and implementation of Mamdani fuzzy controller to generate electric pulses that mimic the natural pacing system of the heart maintains an adequate heart rate by delivering controlled, rhythmic electrical stimuli to the chambers of the patient heart. The proposed controller is tested by using Matlab/Simulink program.

基于家庭远程血压/心率监测系统的医院外心衰管理效果观察

目的分析家庭远程血压/心率监测在左心力衰竭(心衰)合并高血压患者中的医院外应用效果。方法前瞻性选取2020年7月至2021年6月粤北人民医院心血管内科住院确诊为左心衰合并高血压患者420例,根据患者出院后是否同意进行家庭远程血压/心率监测分为远程监测组(112例)和常规随诊组(278例)。远程监测组每天早、晚进行血压和心率测量并上传数据至医护终端,医护团队根据测量结果及时指导患者生活方式、用药及进一步治疗;常规随访组自行测量血压和心率并登记,定期门诊随诊。记录2组患者出院后第1、3、6、12个月血压和心率控制值,非计划再次入院率及时间间距,全因死亡和心血管疾病死亡情况。结果远程监测组患者出院后第1、3、6、12个月收缩压,以及出院后第6、12个月心率均明显低于常规随访组,非计划再次入院率明显低于常规随访组,再入院时间间距明显长于常规随访组,差异均有统计学意义(P<0.05);2组患者全因死亡率、心血管疾病死亡率比较,差异均无统计学意义(P>0.05)。结论家庭远程血压/心率监测有利于平稳控制心衰合并高血压患者出院后的血压和心率,延迟患者再入院时间间距,降低患者再住院率。

How to properly evaluate cardiac vagal tone in oncology studies:a state-of-the-art review

Heart rate variability(HRV)analysis provides an assessment of cardiac vagal tone and consequently global cardiac health as well as systemic condition.In systemic diseases such as cancer and during treatments that affect the whole body,like chemotherapy,the vagus nerve activity is low and deregulated.Some studies focus on using HRV to predict mortality in oncology.However,in cancer patients,systemic alterations substantially increase artifacts during HRV measurement,especially atrial ectopic beats.Moreover,HRV may be altered by various factors(duration and time of measurement,breathing,drugs,and other confounding factors)that alter each metric in different ways.The Standard Deviation of all Normal to Normal intervals(SDNN)is the most commonly used metric to evaluate HRV in oncology,but it does not appear to be specific to the cardiac vagal tone.Thus,cardiac vagal activity diagnosis and vital prognosis of cancer patients can be biased.Our review presents the main HRV metrics that can be currently used in oncology studies and their links with vagus nerve and cancer.We present the influence of external factors and the required duration and time of measurement.Considering all these parameters,this review proposes seven key points for an assessment of HRV and cardiac vagal tone in patients with cancer.

心房颤动节律与心率治疗的获益是否真的差异不大?

目的心房颤动(房颤)的节律和心率治疗是两种常见的治疗策略,目前两者之间的选择仍存在争议,本研究通过荟萃分析评估这两种策略的综合获益。方法在Cochrane Central Register of Controlled Trials、Embase、PMC和Web of Science中搜索随机对照试验。使用STATA 15.0软件来评估研究的效果、敏感性、异质性和发表偏倚。结果研究共纳入了22项试验,42037例参与者。与速率控制组相比,节律治疗获得的主要终点事件更少,且随时间增加更加更为显著。5年随访显示,两组的远期生存率无明显差异。节律控制对左心室射血分数(LVEF,SMD=-0.40,95%CI:-0.68~-0.13,P=0.004)、代谢当量(METs,SMD=-0.42,95%CI:-0.76~-0.08,P=0.016)、运动耐受时间(SMD=-0.71,95%CI:-0.76~-0.49,P=0.000)和生活质量(QOL)评分(SMD=-0.92,95%CI:-1.76,-0.07,P=0.034)的改善更加显著。在节律控制组中缺血性卒中更少(OR=0.85,95%CI:0.78,0.94,P=0.016)。在左心房内径(LAD)、左心室舒张末期内径(LVEDD)、栓塞事件中两种治疗策略无显著性差异。结论恢复窦性心律可显著改善心功能和生活质量,节律控制的综合获益在长期治疗中更为显著。心率控制一直被认为是一种可行的妥协方案,但节律性治疗无疑将是更广阔的发展前景。与之前的指南相比,这项荟萃分析建议采用更积极的节律性治疗。

运动对围绝经期和绝经后妇女心率变异性的调节

心率变异性(heart rate variability,HRV)可以无创定量评估心脏自主神经活动。围绝经期和绝经后妇女由于年龄的增加和体内雌激素水平的降低,导致其心脏自主神经功能异常,心血管疾病的患病风险增加。而适当的运动可以提高雌激素水平,改善心血管健康水平,调节心脏自主神经活动,降低心血管疾病的发生风险。中低强度的有氧运动、抗阻运动、有氧结合抗阻运动和身心运动可对围绝经期和绝经后妇女HRV产生积极影响。总结不同运动方式对围绝经期和绝经后妇女HRV的影响以及运动改善HRV的机制,可为采取更佳的运动策略以改善围绝经期和绝经后妇女HRV提供依据,进而降低心血管疾病的患病风险,提高围绝经期和绝经后妇女的健康水平和生活质量。

心脏康复模式对心房颤动患者心率控制、心理状态及睡眠质量的影响

目的:探讨心脏康复模式对心房颤动患者心率控制、心理状态及睡眠质量的影响。方法:选取2020年4月至2022年4月福建省厦门市社会福利中心松柏医院内科收治的心房颤动患者80例作为研究对象,随机分为对照组和观察组,每组40例。对照组给予常规护理,观察组实施心脏康复模式干预,比较2组护理效果。结果:干预后,观察组汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、匹兹堡睡眠质量指数(PSQI)评分及静息心率、并发症发生率低于对照组(均P<0.05);观察组6 min步行试验(6MWT)、左室射血分数(LVEF)及心房颤动复律率高于对照组(均P<0.05)。结论:心脏康复模式能使心房颤动患者心室率控制在稳定区间,并可促进心房颤动转复为窦性心律,改善心功能,减少并发症发生,提高睡眠质量。

氨氯地平联合贝那普利治疗高血压的效果观察

目的研究氨氯地平联合贝那普利治疗高血压的疗效。方法135例高血压患者,根据用药方式不同分为观察组(68例)和对照组(67例)。对照组给予氨氯地平口服治疗,观察组给予氨氯地平联合贝那普利口服治疗。比较两组血压控制优良率,血压、心率水平,用药不良反应发生率。结果观察组的血压控制优良率97.06%(66/68)高于对照组的83.58%(56/67),差异有统计学意义(P<0.05)。治疗前,两组收缩压、舒张压和心率对比差异无统计学意义(P>0.05);治疗后,两组收缩压、舒张压、心率均低于治疗前,且观察组收缩压(121.18±23.61)mm Hg(1 mm Hg=0.133 kPa)、舒张压(82.32±16.04)mm Hg、心率(69.53±13.55)次/min低于对照组的(130.27±25.19)mm Hg、(88.85±17.18)mm Hg、(76.46±14.79)次/min,差异有统计学意义(P<0.05)。两组用药不良反应发生率对比差异无统计学意义(P>0.05)。结论高血压患者采用氨氯地平联合贝那普利治疗能够控制患者的血压和心率水平,提升血压控制优良率,且保证用药安全,值得推荐。

Guasha improves the rating of perceived exertion scale score and reduces heart rate variability in male weightlifters:a randomized controlled trial

OBJECTIVE: To evaluate the effects of Guasha therapy on the rating of perceived exertion(RPE) scale score, and heart rate variability(HRV).METHODS: A randomized controlled trial of Guasha(skin scraping) was compared with a sham scraping group and control group. Sixteen sessions within an 8-week period were completed. Sixty-five male weightlifters who had undergone normal weightlifting training for a mean of 5 years before study commencement were recruited. The RPEscale score of "snatch", "clean and jerk" maneuvers(85% of one-repetition maximum), and HRV were measured before and after the intervention.RESULTS: The RPE scale score for snatch, clean and jerk were reduced significantly after intervention in the Guasha group and sham group. However, there was a significant difference in the low frequency(LF) domain and LF/high frequency(HF) ratio(P <0.05): the LF domain decreased, and the LF/HF ratio decreased.CONCLUSION: Guasha could be used to reduce the RPE scale score, and increase the response to HRV.Guasha could be considered as an alternative to some types of recovery from sports training.

地尔硫卓与美托洛尔对急性主动脉夹层患者血压和心率的控制效果研究

目的探讨地尔硫卓与美托洛尔对急性主动脉夹层患者血压和心率的控制效果。方法选取2014年10月—2015年10月大连市中心医院心内科收治的急性主动脉夹层患者76例,根据随机数表法分为地尔硫卓组和美托洛尔组,每组38例。地尔硫卓组患者给予盐酸地尔硫卓注射液治疗,美托洛尔组患者给予酒石酸美托洛尔注射液治疗。比较两组治疗前及治疗后:30 min,1 h、6 h的血压和心率。结果两组患者治疗前收缩压比较,差异无统计学意义(P>0.05);美托洛尔组治疗后30 min、1 h、6 h收缩压均低于地尔硫卓组(P<0.05)。两组患者治疗前及治疗后30 min舒张压比较,差异均无统计学意义(P>0.05);美托洛尔组治疗后1 h、6 h舒张压均低于地尔硫卓组(P<0.05)。两组患者治疗前心率比较,差异无统计学意义(P>0.05);地尔硫卓组治疗后30 min、1 h、6 h心率均低于美托洛尔组(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论美托洛尔能够更有效地降低急性主动脉夹层患者的血压,而地尔硫卓能够更加有效地降低患者的心率,因此美托洛尔与地尔硫卓均能够用于治疗急性主动脉夹层。

基于行驶避撞紧急度的车辆运动模糊控制

进行行驶避撞紧急度计算仿真对保证车辆行驶安全具有重要意义.提出基于心率变化的行车避撞紧急度概念,采用驾驶倾向性系数衡量驾驶员基本特征对心率变化的影响,同时给出车辆紧急行驶模糊推理的控制算法,并进行仿真计算.试验结果表明,基本特征对心率变化量影响明显;情况越紧急,驾驶员采用的最大车辆加速度越大,约为-5^-6 m/s2,时间大约为5~7 s之间.加强紧急状况下生理及操纵行为的研究可以更好地理解驾驶行为,为驾驶员安全管理提供理论依据.

音乐放松缓解作业人员应激情绪的研究

目的研究音乐放松对缓解特殊作业人员应激情绪的作用。方法在参加神舟十一号载人航天飞行任务的工作人员中招募志愿者15人,任务过程中和任务后各进行1次音乐放松。在音乐放松前、后采集主观体验指标和唾液皮质醇指标,音乐放松过程中采集心率变异性指标。结果音乐放松后,心率(heart rate,HR)降低[(71.08±7.97)beats/min vs.(68.15±7.05)beats/min)],相邻NN间期差的均方根(root mean square of successive differences,RMSSD)升高[(29.15±13.27)ms vs.(36.86±14.22ms)],高频功率(high frequency,HF)升高[(219.05±180.39)ms^2vs.(329.01±235.87)ms],差异均有统计学意义(P<0.05)。唾液皮质醇(cortisol)水平降低[(6.50±1.04)ng/mL vs.(6.01±0.65)ng/mL],差异接近显著(P=0.079)。结论音乐放松对于缓解作业人员应激情绪具有积极作用,对于下丘脑-垂体-肾上腺(hypothalamo-pituitary-adrenal,HPA)轴和自主神经系统均有影响。

强化心率控制指导药物治疗慢性心力衰竭的临床研究

目的探讨强化心率控制指导药物治疗慢性心力衰竭的疗效及其安全性。方法确诊慢性心力衰竭患者156例,纽约心脏病协会(New York Heark Association,NYHA)分级为II^IV级,所有患者经最佳的药物治疗稳定后,按数字表法随机分为治疗组(78例)和对照组即常规治疗组(78例)。治疗组在常规治疗基础上,以患者清晨静息心率降至55~60次/min为目标心率指导药物治疗。控制心率采用的药物为酒石酸美托洛尔或琥珀酸美托洛尔,酒石酸美托洛尔起始剂量为6.25 mg,2次/d,或琥珀酸美托洛尔起始剂量为11.875 mg/d,根据病情逐渐增至目标剂量或最大耐受剂量。比较两组治疗前及治疗12个月后的NYHA分级、左心室心肌质量、左心室射血分数和左心室后壁收缩期增厚率(△T%)的变化,以及两组全因病死率和心力衰竭恶化住院率。结果治疗12个月后,治疗组患者的临床症状改善情况明显优于对照组(总体有效率:94.8%vs.73.1%,P<0.01);同时,治疗组左心室心肌质量的减少幅度,左心室射血分数和左心室后壁收缩期增厚率的升高幅度均明显高于对照组,且差异有统计学意义(9.39%vs.3.59%,P<0.05;18.34%vs.11.62%,P<0.01;20.43%vs.10.64%,P<0.05);两组均未发生死亡患者,而治疗组因心力衰竭恶化住院治疗的次数明显少于对照组,差异有统计学意义(13次vs.32次,P<0.01)。结论强化心率控制指导药物治疗慢性心力衰竭安全有效,可改善患者临床症状、提高心功能、改善心肌重构,减少因心力衰竭恶化住院治疗次数。

伊伐布雷定减慢心率的研究现状

心率是心血管疾病的主要危险因子。I(f)离子通道抑制剂伊伐布雷定是一类选择性减慢心率的新药,在欧洲已上市3年余,现对其实验及临床研究的现状进行一综述:伊伐布雷定选择性抑制I(f)电流,减慢心率而没有其他心血管效应,单纯减慢心率可改善心肌缺血、内皮功能和心肌收缩功能,长期应用不会增加全因死亡率。其在稳定型冠心病患者中的治疗价值已被证实,但在其他心血管疾病中的应用还需更多的循证医学支持。

基于蓝牙4.0和GSM的无线心率监测仪设计

针对现有的家用心率监测仪器便携性差、报警功能不完善、成本高等问题,提出一种基于蓝牙4.0BLE协议栈和GSM移动通信网络的新型无线心率监测仪设计方案;系统可分为主机和从机两部分;从机由光电式脉搏传感器和蓝牙模块组成,负责测量心率和电量,并将得到的数据实时无线发送给主机;主机由蓝牙模块、单片机、液晶屏和GSM模块组成,负责接收从机发送的信息,并对数据进行监视,同时完成人机交互;实验测试表明,系统可稳定实现心率测量、监视、显示及远程设置、查询和报警功能,与市场上同类产品相比,具有使用便携性好、功耗低、测量准确、多重报警方式及成本低等优点,在家用智能监护领域具有广泛的应用前景。

缺氧复合运动大鼠心肌线粒体功能的变化

目的观察缺氧及缺氧复合运动条件下大鼠心肌线粒体功能的变化。方法将Wistar大鼠分为4组:平原对照组、缺氧组、平原运动组和缺氧复合运动组。缺氧复合运动组大鼠持续暴露于模拟海拔5 000 m高原5周,每天降至4 000 m的高原进行游泳运动1 h(6 d/周),运动结束后回升至5 000 m;缺氧组大鼠同时在低压舱内相同海拔高度饲养,但不进行游泳运动;平原运动组和平原对照组在舱外同时饲养,其中平原运动组每天进行游泳运动1 h(6 d/周)。在末次运动结束后24 h处死大鼠,分离心室肌提取线粒体。用clark氧电极法测定线粒体呼吸功能。结果与单纯缺氧组比较,缺氧复合运动后心肌线粒体ST3、ST4显著增加,呼吸控制率降低;各组线粒体膜电位无显著改变;与平原对照组比较缺氧组大鼠心肌线粒体ATP合成酶α亚基表达显著下降;与单纯缺氧组比较,缺氧复合运动组线粒体ATP合成酶α亚基表达显著增加。结论结果表明缺氧复合运动可改善心肌线粒体3态呼吸,ATP合成酶α亚基表达增加。提示缺氧复合运动后心肌ATP产生效率增加,有氧氧化代谢增强。

上海某社区老年人心房颤动患者的调查

目的:了解社区老年人体检为心房颤动(房颤)的检出率及患者药物治疗情况,为社区开展房颤管理提供依据。方法:收集2018年8月至2019年8月在上海某社区卫生服务中心体检中被心电图诊断为房颤的65岁以上老年人患者的资料,包括临床表现、慢性疾病、特殊药物使用、肝功能、肾功能、心脏超声检查等结果。对其中被诊断为非瓣膜性房颤患者进行卒中血栓危险因素(CHA2DS2-VASc)和出血危险因素(HAS-BLED)评分,并了解患者的复律药物、心率控制药物服用情况。结果:上海某社区共有2971例65岁老年人参加了体检,其中有61人被心电图诊断为房颤,其中2例为瓣膜性房颤,59例为非瓣膜性房颤。非瓣膜性房颤检出率为1.99%;非瓣膜性房颤患者抗凝治疗率为30.19%、心率控制治疗率为52.54%,无复律药物治疗。女性非瓣膜性房颤患者的CHA2DS2-VASc评分高于男性,差异有统计学意义(P<0.05),男性和女性患者间的HAS-BLED评分、抗凝药物使用、心率控制治疗率的差异无统计学意义(P>0.05)。结论:社区老年人房颤的检出率较低,非瓣膜性房颤患者的抗凝治疗率与房颤指南要求有一定距离,很有必要对社区开展房颤规范化管理。

亚健康人群心率变异性特点的研究

目的探讨亚健康状态人群自主神经功能的特点。方法随机选取70例亚健康状态人员,75例健康状态人员分别接受短时(5分钟)心率变异性分析,以正常心动周期的标准差(SDNN)、总功率(TP)、低频功率(LF)、高频功率(HF)、低频功率与高频功率比值(LF/HF)为考察指标,记录并进行统计学分析。结果亚健康状态人群正常心动周期的标准差和总功率都显著低于健康人群(t=-4.643,P=0.00;t=-3.492,P=0.002);同时与健康人群比较,亚健康状态人群的低频功率增高,但未达统计学意义(t=0.898,P=0.377);高频功率有所下降,亦未达到统计学水平(t=-0.899,P=0.376);亚健康状态人群的低频功率与高频功率比值(LF/HF)与健康人群没有差异(t=0.943,P=0.354)。结论亚健康状态人群心率变异性降低,自主神经系统功能减退。