摘要
目的探讨２４ｈ动态心电图心率变异性（ＨＲＶ）特征在飞行人员医学鉴定中的应用价值。方法使用北京新兴生物医学工程研究发展中心研制生产的动态心电图仪及ＨＲＶ分析软件，分析５０名健康飞行员２４ｈＲ－Ｒ间期的时域指标、频域指标和洛伦兹散点图，并与高血压和冠心病病人相比较。结果①健康飞行人员ＨＲＶ的频域及时域指标呈明显的昼－夜节律，低频功率白天增高，夜晚降低；高频功率白天降低，夜晚增高。②健康飞行人员的洛伦兹散点图呈彗星状，少数呈蜂腰状或宽腰状。③在部分高血压及冠心病病人中，ＨＲＶ变化明显，主要表现为时域指标减小；洛伦兹散点图呈鱼雷状、梭状、扇状、匕首状、卫星状、火箭状和青蛙状等。频域指标呈现昼－夜节律障碍，Ⅰ期高血压病人多数表现有夜间低频功率／高频功率比值（ＬＦ／ＨＦ）增高；Ⅲ期高血压病人表现为２４ｈＬＦ／ＨＦ全面降低并有总功率降低。结论２４ｈＨＲＶ分析对健康飞行员和心血管病人有明显的鉴别意义，在飞行人员医学鉴定中有应用价值。
ObjectiveThisstudyaimedatexploringthecharacteristicsof24-hheartratevari-ability(HRV)inpilotsanditssignificanceinclinicalaviationmedicine.MethodsUsing24-hHoltermonitoringandsoftwareforanalysingHRV,thetimedomainparameters,frequencydomainparametersandLorenzplotsof24-hR-Rintervalwereobtainedin50healthypilotsandcomparedwiththoseofhealthygroundcrew,andpatientswithcardiovasculardiseases.Results①Inthehealthypilots,thefrequencyandtimedomainparametersofHRVappearedtohaveapparentcircadianrythm,theirhourlyfiguresoftheHFpowerdecreasedduringdaytime,andincreasedduringthenight,whereastheLFde-creasedduringthenight,andincreasedduringthedaytime.Thecircadianrythmwasnotobservedinmostofthepatientswithcardiovasculardiseases.②InhealthypilotsLorenzplotsshowedacharacteris-ticcomet-shapedpatern.Afewofthemappearedtobeatypicalcomet-shapedpatern,whilethepat-ternofLorenzplotsinpatientsweretorpedo-shaped,shutle-shaped,dagger-shaped,satelite-shaped,missile-shaped,fan-shapedandfrog-shaped.ConclusionThisstudyindicatedthatHRVisasensi-tiveandusefultoolinmedicalselectionandevaluationofpilots.
