透過您的圖書館登入
IP:3.237.0.123
  • 學位論文

冠狀動脈疾病中年婦女疾病狀態、身體活動度對其心率變異度之相關性探討

Relationships Among Disease Status、Physical Activity and Heart Rate Variability in Middle-Age Women With Coronary Artery Disease

指導教授 : 鄭綺

摘要


過去研究顯示,未停經的婦女與同年齡男性相比,罹患冠狀動脈疾病的比率遠低於男性,以2009年死因統計來看,心血管疾病已是女性首要死亡原因。先前研究結果顯示,冠狀動脈疾病狀態及身體活動度均會導致心率變異度下降。本研究主要目的在探討冠狀動脈疾病中年婦女疾病狀態及身體活動度對其心率變異度之相關性探討,研究設計採橫斷式相關性之研究,經由立意取樣,選取北部某醫學中心心臟內科病房進行心導管檢查患者,共收集69位個案,分為無CAD組及CAD組之中年婦女患者為研究對象,並以結構式問卷量表及生理訊號擷取系統,對研究對象進行訪談及測量,問卷包含個案基本屬性資料表、疾病嚴重度量表、症狀嚴重度量表、七日身體活動回憶量表。資料分析採百分比、平均值、標準差呈現描述性統計,再以Chi-square 及t-test 、Spearman Correlation、Mulitiple regression with Stepwise regression進行檢定。 研究結果顯示,(一) 冠狀動脈疾病婦女相較於無CAD婦女,在休息狀態下,心率變異度之參數包括TP(ms2)、LF(ms2)、HF(ms2) 均顯著低於無CAD婦女,並達統計上顯著差異(p<0 .05)。 (二) 冠狀動脈疾病婦女之疾病嚴重程度總分最少計8 分,最嚴重達210分,平均疾病嚴重程度為43.59±53.52分,疾病嚴重度與心率變異度參數無統計上相關性。(三) 冠狀動脈疾病中年婦女之症狀嚴重程度總分最少為15,最高為40 分,整體平均症狀嚴重程度為26.31±6.8分。其中以呼吸喘症狀平均總分最高9.97±2.9分,其次是胸痛症狀平均總分8.41±4.1分。症狀嚴重度中疲倦與心率變異度HF(ms2) 統計上呈現正相關(r=0.39、p=0.02)。(四) 冠狀動脈疾病中年婦女在身體活動度中的每周相對中重度身體活動量(r=0.39、p=0.01)或絕對中重度身體活動量(r=0.43、p=0.00)與心率變異度參數之TP(ms2)呈現正相關,即中重度身體活動量愈高,即整體的心率變異度愈高。 (五) 心率變異度中的TP(ms2)預測因子為每日絕對中重度身體活動量,此變項可以解釋冠狀動脈疾病中年婦女心率變異度中的TP(ms2)總變異量的12.5%。 研究顯示,冠狀動脈疾病中年婦女心率變異度低於無CAD婦女,且須採中等強度以上之身體活動量對心率變異度才具有差異性,可提供臨床醫護人員參考及應用。

並列摘要


Previous researches have showed that premenopausal women suffered less cardiovascular risk than men in the same age . But from the statistics of cause of death in 2009, cardiovascular disease has become the leading cause of death in women. The previous researches have showed that, the status of coronary artery disease (CAD) and physical activiy will affect heart rate variability (HRV). The main purpose of this study is to investigate the correlation between both disease status and physical activity and HRV among the middle-aged women who suffer from cardiovascular disease. Cross-sectional study design was used. Through purposive sampling, the patients with cardiac catheterization in a medical center of northern country were recruited. A total of 69 cases were collected and divided into CAD and non-CAD groups of middle-aged women. We performed interviews and physiological measurement to these patients using the physiological acquisition system and a structured questionanaire. The questionnaire included the informations of basic attribute, disease severity, symptom severity, and the seven-day physical activity recall scale. Data were collected and described in percentage, mean, and standard deviation, and then analyzed by Chi-square, t-test, spearman colleration, and multiple regression with stepwise regression. The results show that a) HRV factors, including TP(ms2), LF(ms2) and HF(ms2), of women who suffered from CAD were lower than those of women who had no CAD, indicating a significant difference (p<0.05). b) The lowest CAD severity score is 8 points and highest 210 points. The average severity of illness is 43.59±53.52 points. However, the disease seveirty shows no statistical correlation with HRV. c) The lowest total score of symptom severity is 15 points and the highest 40 points. The overall average symptom severity score is in 26.3±16.8. Among these symptoms, dyspnea has the highest average score 9,97±2.9, followed by chest pain, 8.41±4.1. Among the symptom severity score, the fatigue shows positive correlation between HF (ms2) and HRV factors.(r = 0.39、p = 0.02). d) The patients who had relative moderate to severe degree of physical activity(r = 0.39、p = 0.01) or absolute moderate to severe degree of physical activity(r = 0.43、p = 0.00) per week shows positive correlation with TP(ms2). e) The predictor for TP (ms2) was the daily absolute moderate to severe physical activity score. This variability could explain 12.5% of overall variance of TP (ms2) of women with CAD. This study shows that middle-aged women with CAD have lower HRV than women without CAD do. Besides, moderate physical activity or above would be beneficial to these patients. These results could be helpful for clinical physician and nursing staff for caring these patients.

參考文獻


杜詩婷(2008)•居家運動計畫對改善停經後合併有冠狀動脈疾病婦女心率變異度及心肺耐力之成效探討.未發表的碩士論文,台北醫學大學,臺北。
毛祚彥、陳清淵、邱定宇、林貴福(2007).冠狀動脈心臟病患者危險因子與休閒身體活動量之評估分析.國際運動生理與體能領域學術研討會,108-108。
黃文增、譚旦旭、曾國剛、張淵仁、陳錦杏(2010)•即時疲勞度之偵測研究與分析•資訊科技國際期刊, 4(1),119 -138。
陳淑如、蔡月霞、羅映琪、蔡宜珊、鄭綺(2005).心率變異度的簡介及護理上的應用.新臺北護理期刊,7(1),1-10。
蔡仁貞(1999).心臟病患對心臟復健工作的認知與實施需求之探討.新臺北護理期刊,1(1),59-67。

延伸閱讀