心跳變異生理回饋運用於冠狀動脈心臟病患者的敵意和自主神經調節

目的：敵意會增加冠狀動脈心臟病 (coronary artery disease, CAD)患者罹患、復發和死亡率，可能的生理病理機制之一為自主神經的失衡，包括交感神經過度活化或副交感神經/迷走神經弱化。研究發現心跳變異生理回饋 (heart rate variability biofeedback, HRV-BF)可增加個體自主神經的平衡並降低死亡率，但尚未有研究運用於降低CAD患者的敵意特質和生氣時的生理反應。本研究主要目的在檢驗HRV-BF在CAD患者之敵意和自主神經調節的療效。研究方法：31名穩定的CAD患者隨機分派為治療組 (3女/14男，平均56.47 ± 9.53歲)和等候控制組 (3女/11男，平均60.57 ± 9.30歲)，治療組接受連續六周的HRV-BF。兩組均接受前後測的短式華人敵意量表、自主神經功能、血壓以及心跳之測量，以進行HRV-BF之療效檢驗。研究結果：慢性療效之組內檢定發現，治療組在三個測量時間點的基準期迷走神經活性 (ln LF)具有顯著之差異 (F (2, 38) = 4.39, p < .05)，事後檢定發現追蹤的ln LF顯著高於前測 (p < .01)。另外，急性療效之組內檢定發現，治療組在三個測量時間點的恢復期低頻與高頻比值 (LF/HF ratio)改變量具有顯著差異 (F (2,34) = 3.38, p < .05)，事後檢定發現後測之低頻與高頻比值改變量顯著高於前測，而追蹤的低頻與高頻比值改變量雖高於前測、但未達顯著 (p = .07)。最後敵意特質之組內檢定發現，治療組在後測和追蹤之表達敵意、壓抑敵意以及敵意總分均低於前測；而追蹤的敵意認知和敵意情感分數低於前測，且追蹤之敵意認知亦低於後測。結論：本研究支持HRV-BF有助於協助CAD患者改善其自主神經失衡的慢性效應和生氣事件後的調節歷程，並且在長時間追蹤後可顯著降低CAD患者的敵意特質。

關鍵字

敵意；冠狀動脈心臟病；自主神經調節；心跳變異生理回饋

並列摘要

Objective: Hostility has been confirmed as a coronary artery disease (CAD) risk factor and increased CAD morbidity, recurrence, and mortality. One of pathphysiological mechanism of CAD is autonomic nervous system imbalance that causes sympathetic hyperactivity or parasympathetic hypoactivity/ vagal withdrarwal. Heart rate variability biofeedback (HRV-BF) has been used in increasing autonomic balance and decreasing cardiovascular mortality. However, there is a lack of research using HRV-BF in hostility trait/ anger regulation in CAD patients. The purpose of this study is to confirm HRV-BF program in hostility trait and autonomic regulation in CAD patients. Methods: Thirty-one CAD patients were randomly assigned to HRV-BF group (3female/14 male, mean age = 56.47 ± 9.53 year-old) and wait-list control group (3 female/11male, mean age = 60.57 ± 9.30 year-old). HRV-BF group received HRV-BF once per week for 60-min for six weeks. Chinese Hostility Scale_Short Form, HRV, blood pressure and heart rate were measured at pre-test , post-test and one month follow-up. Results: The result of this study found that there were increased baseline low-frequency power of HRV at post-test and follow-up than pre-test. There was significantly increased the change score of low frequency to high frequency ratio (LF/HF ratio) at post-test than pre-test. There were significant decreased in expressive hostility, suppressive hostility, and total hostility score in post-test than pre-test, as well there were significantly decreased in hostility cognition and hostility affect at follow-up than pre-test. Conclusion: This result support that HRV-BF can improve autonomic regulation and recover from anger recall task. In addition, there was decreased hostility trait in CAD patients at one month follow-up.

並列關鍵字

hostility ； coronary artery disease ； autonomic nervous system regulation ； heart rate variability biofeedback

參考文獻

Brosschot, J., & Thayer, J. (1998). Anger inhibition, cardiovascular recovery, and vagal function: A model of the link between hostility and cardiovascular disease. Annals of Behavioral Medicine, 20(4), 326-332. doi: 10.1007/bf02886382

Chida, Y., & Steptoe, A. (2009). The association of anger and hostility with future coronary heart disease: A meta-analytic review of prospective evidence. Journal of the American College of Cardiology, 53(11), 936-946. doi: 10.1016/j.jacc.2008.11.044

Cook, W. W., & Medley, D. M. (1954). Proposed hostility and Pharisaic-Virtue Scales for the MMPI. Journal of Applied Psychology, 38(6), 414-418. doi: 10.1037/h0060667

Demaree, H. A., & Everhart, D. E. (2004). Healthy high-hostiles: Reduced parasympathetic activity and decreased sympathovagal flexibility during negative emotional processing. Personality and Individual Differences, 36(2), 457-469. doi: 10.1016/s0191-8869(03)00109-0

Pumprla, J., Howorka, K., Groves, D., Chester, M., & Nolan, J. (2002). Functional assessment of heart rate variability: Physiological basis and practical applications. International Journal of Cardiology, 84(1), 1-14. doi: 10.1016/s0167-5273(02)00057-8

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心跳變異生理回饋運用於冠狀動脈心臟病患者的敵意和自主神經調節

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