- 學位論文
敵意對原發性高血壓患者心血管與自主神經系統反應之影響
The impact of the hostility with the cardiovascular and autonomic nervous system reaction among essential hypertension patients
摘要
目的：敵意對於心血管疾病的風險與死亡率具有預測力，能透過自主神經系統等生理機制影響心血管疾病的發展。高血壓被認為與表達敵意(expressed hostility) 和壓抑敵意(suppressed hostility)皆有關，相關心理生理病理路徑尚未有一致性的結果。本研究欲檢驗不同敵意行為模式對於原發性高血壓患者的心血管與自主神經反應之影響。 方法：本研究納入原發性高血壓患者共40名(20位女性)，平均年齡為52.30歲(SD = 8.86)。以短式華人敵意量表將受試者區分為高表達敵意組、高壓抑敵意組和對照組；所有參與者均進行中性、算術與生氣回憶等壓力作業，同時測量心血管與自主神經反應，以檢驗敵意行為模式與心血管和自主神經反應之關聯性。 結果：發現原發性高血壓患者在生氣回憶期有較明顯的血壓反應，收縮壓( F = 10.804, p < .001)與舒張壓(F = 12.855, p < .001)之反應量皆較算術期與中性回憶期大，但在心跳和自主神經反應上則未達顯著差異。表達敵意和壓抑敵意之自主神經具有不同的反應型態，在生氣回憶期之交感神經指標(LF/HF ratio)有組別與階段交互作用的顯著差異(F = 3.852, p < .05)。表達敵意與生氣回憶期之LF/HF ratio呈正相關(r = .576, p < . 01)，且表達敵意組在生氣回憶期之LF/HF ratio反應顯著高於高壓抑敵意組與對照組(事後檢定p < .05；p < .01)，顯示有交感神經過度反應的現象。壓抑敵意與生氣回憶期之副交感神經指標(HF) 呈正相關(r = .339, p < . 05)，且壓抑敵意組在生氣回憶期之HF反應量顯著高於表達敵意組與對照組(事後檢定p < .05)。 結論：本研究支持原發性高血壓患者在生氣回憶期有較強的血壓反應，且表達敵意和壓抑敵意在自主神經具有不同的反應型態，表達敵意在生氣回憶期支持交感神經過度活化反應，壓抑敵意則可能因該組實驗參與者以女性為居多(女:男= 6:1)的影響，導致較高的副交感神經活性，未能驗證副交感神經弱化的現象需排除性別可能造成的影響後，再進一步釐清其自主神經反應型態。
並列摘要
Objective: Expressive hostility and suppressive hostility had been found to be related to cardiovascular reactivity in essential hypertensive patients; however, there are still controversies. Similarly, Autonomic imbalance is characterized by a hyperactive sympathetic system and a hypoactive parasympathetic system, but the automatic activation in essential hypertensive patients is unknown. The purpose of this study was to investigate the relationship between hostility behavior pattern and reactivity of cardiovascular and autonomic system among essential hypertension. Methods: This study recruited 40 essential hypertension patients (mean age = 52.30 ± 8.86; 50% were female). Chinese Hostility Inventory Short Form (comprehend expressive hostility and suppressive hostility) were administrated for all participants and then participated for the experimental task as the following sequence: resting baseline, neutral recall task (NR), Mental Arithmetic task (MA), and Anger Recall task (AR). The blood pressure, heart rate, and electrocardiogram were monitored continuously and heart rate variability (HRV) was calculated. Results: The results of this study were found that the blood pressure was increased under anger situation and was increased significantly low frequency to high frequency ratio (LF/HF ratio) at AR task among high expression of hostility subjects. The high frequency (HF) was increased among suppressed hostility subjects at AR task, which may be affected by gender differences between groups. Conclusion: These results support the hypothesis that high expressions of hostility were sympathetic hyperactivity under anger situation, which may initiate and hasten the development of hypertension. High suppression of hostility may need further verify the parasympathetic hypoactivity hypothesis.