目的：探讨维持性血液透析（MHD）失眠患者心率变异性的昼夜节律特点以及其与子午流注规律的关系。方法：选取符合失眠标准的MHD患者，分析其心率变异性（HRV）的主要指标，用匹兹堡睡眠评分系统（PSQI）反映患者睡眠情况，取29例性别、年龄相互匹配的健康人（无肾脏病）作为对照组；比较患者心率变异性的时域指标及频域指标与健康人有无统计学差异，描述患者心率变异性随子午流注时辰变化的特点。结果：本研究共纳入患者21例，24h心电图结果提示患者心率变异性时域指标的全程每5min R-R间期平均值的标准差（SDANN，P=0.004)、相邻R-R间期之间差值的均方根（rMSSD，P=0.016）以及频域指标24h频域总功率较健康组有显著的差异（P=0.010）；根据子午流注时辰划分方法，观察患者的HRV可见，患者每个时辰的SDNN平均值都在150以上，最低值出现在寅时（24h计时的3:00-4:00）并开始上升，上升速度十分缓慢，峰值在巳时（24h计时的9:00-10:00）并由此开始逐渐下降，未时（24h计时的13:00-14:00）重新降回夜间水平波动。结论：维持性血液透析失眠患者的HRV 随着子午流注十二时辰的变化表现出一定的节律。

The present study aimed to investigate the relationships between the function of autonomic nervous system and quality of sleep by demonstrating the circadian rhythm of heart rate variability(HRV)in patients with maintenance hemodialysis(MHD)and insomnia, figuring out the potential links between Zi Wu Liu Zhu(ZWLZ)rules and HRV.In this study,HRV of all subjests was measured by time-domain index and frequeneydomain index with Holter,while the severity of insomnia using Pittsburgh sleep quality index(PSQI)among 21 hemodialysis patients.Diurnal variation of HRV in hemodialysis patients with insomnia was analyzed rested on ZWLZ rules.Characteristics of HRV changes along with ZWLZ Rules was preliminarily confirmed.It was found that SDNN and SDANN values were significantly different between MHD patients with insomnia and healthy subjects.The HRV average value of MHD patients was over 150 based on ZWLZ rules.The minimum value occured during YIN solar day period(3:00a.m.to 4:00a.m.),while the highest value during SI solar day period(9:00a.m.to 10:00a.m.).In conclusion,it was demonstrated the diurnal variation rules behind the HRV of MHD,and differring from the healthy subjects.

科学技术部“十二五”国家科技支撑计划（2013BAI02B04）: 中医药治疗慢性肾脏病5期（非透析）的效果比较研究，负责人：刘旭生；广东省中医药局2015年度广东省中医院中医药科学技术研究专项（YN2015MS25）：耳穴按压治疗血液透析患者睡眠障碍的疗效与安全性评价，负责人：林启展。