心跳變異生理回饋對冠心病患者在心臟自主神經反應量與恢復量之療效

目的：研究證實生氣容易導致冠心病(coronary artery disease, CAD)患者發生心血管事件，其中可能的生理病理機制為交感神經(sympathetic nerve system, SNS)過度活化或迷走神經(vagus nerves)弱化。心跳變異生理回饋(heart rate variability biofeedback, HRV-BF)已經被證實能改善CAD患者在休息狀態下的SNS活化或迷走神經弱化，反映在心跳變異(heart rate variability, HRV)指標。本研究目的為驗證HRV-BF是否可以改善CAD患者在生氣作業下的自主神經系統(autonomic nerves system, ANS)反應量與生氣作業後的ANS恢復量。方法：84名病情穩定之CAD患者分派至治療組(n = 40；平均年齡60.58 ± 7.08；37男與3女)或控制組(n = 44；平均年齡58.98 ± 6.25；41男與3女)，治療組接受六週HRV-BF，控制組則在後測後接受單次心臟衛教。兩組均接受前測與後測的ANS測量，包含基準期、中性陳述期、恢復期一、生氣陳述期與恢復期二之HRV。生氣陳述HRV恢復量，為恢復期二HRV與生氣陳述期HRV之差異。結果：治療組與控制組在前測與後測實驗五階段之SDNN、LF與lnLF的三因子交互作用達顯著差異，治療組相較控制組在後測的基準期、恢復期一與恢復期二有較高的LF與lnLF；此外，治療組的後測相較前測在基準期有較高的SDNN、LF與lnLF，在恢復期一與恢復期二有較高的LF與lnLF。治療組與控制組在前測與後測的生氣陳述LF與lnLF恢復量之二因子交互作用達顯著差異，治療組相較控制組在後測有較高的生氣陳述LF與lnLF恢復量，且治療組在後測恢復期二的SDNN、LF與lnLF與後測基準期的SDNN、LF與lnLF沒有顯著差異，表示治療組在生氣陳述後可以恢復至基準期。結論：本研究證實HRV-BF可以提升CAD患者在基準期與生氣陳述後恢復期的ANS反應，以及提升生氣陳述ANS恢復量。

關鍵字

心跳變異生理回饋；生氣作業；自主神經反應量；自主神經恢復量；冠狀動脈心臟病

並列摘要

Objective: Prvious studies had been confirmed cardiovascular events were related with anger emotion among patients with coronary artery disease (CAD). The underlying psychophysiological mechanisms may be higher sympathetic nerve system (SNS) activity and lower vagus nerves activity that reflect on heart rate variability (HRV). There were evidences of the efficacy of heart rate variability biofeedback (HRV-BF) among patients with CAD in improving autonomic nerves system (ANS) activations in resting state, but not in anger state. Therefore, the aim of this study is to examine the ANS reactivity and recovery of anger recall task among patients with CAD after participating HRV-BF. Methods: A total of 84 patients with CAD were assigned to the treatment group (n = 40; 60.58 ± 7.08 years; M: F = 37: 3) or the control group (n = 44; 58.98 ± 6.25 years; M: F = 41: 3). The treatment group received six weeks HRV-BF, and the control group received psychosocial education after posttest. ANS measurements were admisirited at baseline, neutral recall task, recovery 1, anger recall task and recovery 2 for both groups. Anger recovery of HRV was defined by HRV in recovery subtract HRV in anger recall. Results: Treatment group and control group in pre and post ANS measurement had Three ways interaction effects (2 Gropus * 2 Times * 5 Stages) on SDNN, LF, and lnLF were significantly. Treatment group had higher LF and lnLF in baseline, recovery 1 and recovery 2 than control group at posttest. In treatment group, there were higher SDNN, LF and lnLF in baseline, higher LF and lnLF in recovery 1 and recovery 2 at posttest than that at pretest. Two ways interaction effects (2 Gropus * 2 Times) on anger recovery were significantly on LF and lnLF. Treatment group had higher LF and lnLF anger recovery than control group at posttest. No significant difference on SDNN, LF and LF between recovery 2 and baseline at posttest for treatment group. This indicated that treatment group recover to baseline after anger recall task. Conclusion: This study confirmed that HRV-BF increases ANS activations in baseline and recovery 2, and improve anger recovery among patients with CAD.

並列關鍵字

heart rate variability biofeedback ； anger task ； autonomic nerves system reactivity ； autonomic nerves system recovery ； coronary artery disease

參考文獻

Lewis, G. F., Hourani, L., Tueller, S., Kizakevich, P., Bryant, S., Weimer, B., & Strange, L. (2015). Relaxation training assisted by heart rate variability biofeedback: Implication for a military predeployment stress inoculation protocol. Psychophysiology, 52(9), 1167-1174. doi:10.1111/psyp.12455

中華民國行政院衛生福利部統計處(2016)。「死因統計-中華民國一百零五年」。http://dep.mohw.gov.tw/DOS/lp-3352-113.html