运动负荷下心音心电同步监测技术连续无创评估左心室收缩功能  

Exploration of continuous noninvasive assessment of left ventricular systolic function under exercise load by using simultaneous cardiac sounds and electrocardiographic signals monitoring technology

作　　者：臧峰 仲崇发[2] 曹江北 马利彬 王跃[2] 黄泽民[2] 吴斌[2] 徐冲[2] Zang Feng;Zhong Chongfa;Cao Jiangbei;Ma Libin;Wang Yue;Huang Zemin;Wu Bin;Xu Chong(Beijing Sport University,Beijing 100084,China;China Astronaut Research and Training Center,Beijing 100094,China;Department of Anesthesiology,The First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]北京体育大学,北京100084 [2]中国航天员科研训练中心,北京100094 [3]中国人民解放军总医院第一医学中心麻醉科,北京100853

出　　处：《中华航空航天医学杂志》2023年第4期220-225,共6页Chinese Journal of Aerospace Medicine

摘　　要：目的通过可穿戴心音心电同步监测技术连续无创评估运动负荷状态下左心室收缩功能,为实现长时间连续监测航天员在航天活动中心功能变化提供参考。方法招募11名健康男性青年为研究对象。受试者在卧位功率自行车上进行递增负荷运动,50 W起步,每3 min递增25 W,最高达到125 W。选取受试者在静息状态下、运动过程中每级负荷1 min后以及运动结束后3 min的心音心电信号进行分析;运动前、后5 min受试者行经胸心脏超声检查。对心音心电信号指标和左心室射血分数(left ventricular ejection fraction,LVEF)进行相关性分析,并建立在运动过程中预测LVEF的回归模型。结果不同运动负荷状态下,受试者心率、LVEF、电-机械活动时间(electromechanical activation time,EMAT)、左心室射血时间(left ventricular ejection time,LVET)差异均有统计学意义(F=53.22、45.33、3.65、23.19,P<0.001、<0.001、=0.011、<0.001);与静息状态比较,受试者在运动负荷过程中心率和LVEF增加,EMAT和LVET降低,差异均有统计学意义(P<0.01或0.05)。相关性分析显示,LVEF与EMAT、LVET呈负相关(r=-0.415、-0.758,P=0.002、<0.001),与第1心音的幅度呈正相关(r=0.606,P<0.001)。通过EMAT、LVET建立预测LVEF的模型,多元回归模型为LVEF=108.698-0.092×LVET-0.134×EMAT(r=0.87,P<0.001)。结论通过心音心电信号同步监测技术可在运动负荷下连续无创监测运动中的LVEF变化状态;LVET与LVEF的关系最为密切;LVEF有助于预测航天员在航天活动过程中心脏功能的变化。Objective To provide references for achieving long time continuous monitoring of cardiac functional changes of astronauts in spaceflight activities through continuously noninvasive assessment of left ventricular systolic function under exercise load by wearable cardiac sounds and ECG signals synchronization monitoring technology.Methods Eleven healthy male youths were recruited for the study,and they did incremental load exercise on the recumbent power bicycle,starting at 50 W,increasing by 25 W every 3 minutes,until the maximum of 125 W reached.The subjects′cardiac sounds and ECG signals at rest,1 min after each level of load during exercise and 3 min after the end of exercise were selected;the transthoracic cardiac ultrasound examination of subjects was performed before and 5 min after exercise.The correlation between the cardiac sounds and ECG signals and left ventricular ejection fraction(LVEF)was analyzed,and a regression model was established to predict LVEF during exercise.Results There were significant differences in heart rate,LVEF,electro-mechanical activation time(EMAT)and left ventricular ejection time(LVET)of subjects under different exercise loads(F=53.22,45.33,3.65,23.19,P<0.001,<0.001,=0.011,<0.001).Compared with the resting state,subjects showed increased heart rate and LVEF and a decreased EMAT and LVET during exercise loading,all of which were statistically significant(P<0.01 or 0.05).In the correlation analysis,LVEF was negatively correlated with EMAT and LVEF(r=-0.415,-0.758,P=0.002,<0.001),and positively correlated with the amplitude of the first heart sound(r=0.606,P<0.001).The model for predicting LVEF was established by EMAT and LVET,and the multiple regression model was LVEF=108.698-0.092×LVET-0.134×EMAT(r=0.87,P<0.001).Conclusions The synchronous monitoring technology of cardiac sounds and ECG signals can continuously and non-invasively monitor LVEF changes during exercise.LVET is the most closely related to LVEF.LVEF is hopeful to predict the changes of cardiac function of astronau

关 键 词：心音 心电描记术 心室功能 左 运动负荷 

分 类 号：R851[医药卫生—航空、航天与航海医学]