佛教師子王臥對冠狀動脈疾病患者及孕婦自律神經活性的效應

The Effect of Lion King Recumbency on Autonomic Nervous Activity in Patients with Coronary Artery Disease and Pregnant Women

陳高揚(Gau-Yang Chen) ； 郭正典(Cheng-Deng Kuo)

《佛學與科學》 2卷1期 (2001/01) Pp. 7-20

https://doi.org/10.30162/BS.200101.0006

摘要

老化與疾病均會導致副交感神經活性的下降，而且副交感神經活性下降的程度與疾病嚴重度或預後有關，如果有生理性的副交感神經活性加強法，則值得推薦給病人。佛教對比丘及比丘尼的規範是臥時應採取右側臥，傳統文物中佛像的臥姿也都是右側臥，這種右側臥的臥法被稱為師子王臥。本研究針對老年人、孕婦與冠狀動脈疾病病人，利用心率變異度分析法分別研究不同臥姿對自律神經活性的影響，希望找出對這些人比較適合的臥姿，並驗證佛教師子王臥的正確性。
我們發現右側臥的臥姿除了對正常年輕人有提升副交感神經活性作用之外，在老年人、冠狀動脈疾病的患者與發生急性心肌梗塞的患者也有相同的效果。若以三組患者做比較，則由仰臥轉變為右側臥時，副交感神經活性上升的比率是以急性心肌梗塞患者最大，冠狀動脈疾病患者次之，正常冠狀動脈攝影者最小。因此在急性心肌梗塞患者，副交感神經活性比老年人與穩定的冠狀動脈患者都小，但改採右側臥時，其副交感神經活性上升的比率則比老年人與穩定的冠狀動脈患者都大，而且副交感神經活性愈低者，改採右側臥時其副交感神經活性上升的比率也愈高，所以在急性心肌梗塞患者，右側臥也可以產生最大的副交感神經活性與最低的交感神經活性。在沒有發生嚴重心率緩脈或房室阻斷的急性心肌梗塞患者，可以儘量採取右側臥的臥姿，來當做有效的副交感神經活性加強法。
懷孕末期的孕婦當不自主地採取左側臥，因此英國高血壓學會曾建議，測量懷孕婦女的血壓時應該避免讓孕婦採取仰臥及右側臥，而應採取左側臥。我們發現與未懷孕婦女比較時，懷孕末期孕婦的副交感神經活性在仰臥與右側臥均顯著降低，仰臥時交感神經活性顯著上升。未懷孕婦女的副交感神經活性是以右側臥時最高，而懷孕末期孕婦的副交感神經活性在左側臥及右側臥時相差無幾，但其交感神經活性則以右側臥時較高。與未懷孕婦女比較，由於懷孕所造成的副交感神經活性下降的程度在左側臥時比在仰臥時及右側臥都來得低，故左側臥是比較適合懷孕末期孕婦的臥姿。主動脈及下腔靜脈受到子宮的壓迫是造成懷孕末期孕婦自律神經活性變化的重要機轉，此種自律神經活性的變化也會在產後三個月恢復正常，產後主動脈與下腔靜脈受子宮壓迫的解除可能是產後自律神經活性正常化的主要因素。
為了達到休息的目的，正常人、冠狀動脈疾病患者與急性心肌梗塞患者臥床時應採取右側臥，懷孕末期的孕婦則應採取不致引起神經活化及副交感神經活性受壓抑的左側臥。

關鍵字

佛教 ； 師子王臥 ； 心率變異度 ； 自律神經活性 ； 冠狀動脈疾病 ； 急性心肌梗塞 ； 懷孕

並列摘要

Aging and many diseased states have been shown to be associated with depressed vagal activity. The extent of vagal depression correlates with the severity and poor prognosis of the disease. It will be desirable if there is physiological vagal enhancing method. Right lateral decubitus position or so-called Lion King recumbency is the suggested recumbent position in Buddhism. The traditional statute of Buddha always takes the right lateral decubitus position in recumbency. The study investigated the effect of different recumbent positions on the autonomic nervous activity in patients with coronary artery disease and in pregnant women using spectral heart rate variability analysis. The aim of this study was to find the best recumbent position in these subjects and to verify the Buddhist regulations on recumbency.
We found that the right lateral decubitus position can lead to the highest vagal modulation among 3 recumbent positions in young healthy subjects, aged person, patients with coronary artery disease and patients with acute myocardial infarction. The patients with acute myocardial infarction were found to have more depressed vagal activity than those with coronary artery disease and patent coronary controls. The vagal enhancing effect of changing from supine to right lateral decubitus position was more pronounced in patients with acute myocardial infarction than those with coronary artery disease and patent coronary controls, and was more obvious in those patients who had more depressed vagal activities.
Women in their late pregnancy assume left lateral decubitus position involuntarily. The assumption of left lateral decubitus position and the avoidance of supine and right lateral decubitus positions have been recommended during blood pressure measurement in pregnant women by the British Hypertension Society. We found that late pregnant women had lower vagal activity in supine and right lateral decubitus positions and had higher sympathetic activity in supine position than those of non-pregnant women. The non-pregnant women had the highest vagal activity in right lateral decubitus position during recumbency. In late pregnant women, the vagal activity was significantly decreased in supine and right lateral decubitus positions than that of left lateral decubitus position as compared to those of non-pregnant woman, and the sympathetic activity was higher in right lateral decubitus position than that of left lateral decubitus position. The left lateral decubitus position is therefore a better position during recumbency for late pregnant women. Aortocaval compression might be responsible for the derangement in the autonomic nervous system during recumbency in late pregnancy. The derangement in autonomic nervous activity observed in late pregnant women was normalized 3 months after delivery. The release of aortocaval compression might be responsible for this return of autonomic nervous activity to near normal after delivery.
It is recommended that the young healthy subjects, aged persons, patients with coronary artery disease and patients with acute myocardial infarction should assume right lateral decubitus position during recumbency, whereas the late pregnant women should assume left lateral decubitus position during recumbency to avoid sympathetic activation and vagal suppression.

並列關鍵字

Buddhism ； Lion King recumbency ； heart rate variability ； autonomic nervous activity ； coronary artery disease ； acute myocardial infarction ； pregnancy