焦虑症患者与正常人心率变异性的比较及腹式呼吸训练对焦虑症患者心率变异性的影响
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摘要
本研究目的有二：一、研究焦虑症患者自主神经系统的功能特点。二、探讨腹式呼吸训练治疗焦虑症的可能性。
为了研究焦虑症患者自主神经系统的功能特点，本研究对40名焦虑症患者和40名健康志愿者进行短时程(10分钟)心率变异性(HRV)分析，参数为平均心率，正常RR间期的标准差(SDNN)，相邻RR间期差的均方根(rMSSD)，相邻RR间期差异≥50毫秒的百分数(PNN50)以及心率变异系数(HRVⅠ)即RR间期总数目与占比例数最大的RR间期的数目之比。结果：焦虑症患者组平均心率高于正常对照组(P＜0.001)，焦虑症患者组SDNN、rMSSD、PNN50及HRVⅠ均低于正常对照组(P＜0.001)。提示：焦虑症患者自主神经功能下降，以迷走神经张力下降为主，交感神经活性相对亢进。
为了探讨腹式呼吸训练治疗焦虑症的可能性，本研究将64名焦虑症患者分为两组，33名患者接受腹式呼吸训练(实验组)，31名患者不接受腹式呼吸训练(控制组)，两组在实验前后对心率变异性进行极测，参数同上。实验组和控制组各参数的基线值无差异。结果：实验纽进行腹式呼吸训练后，平均心率下降，SDNN、rMSSD、PNN50及HRVⅠ均显著提高(P＜0.001，对照组各指标前后无显著性差别。提示：腹式呼吸训练能够提高焦虑症患者自主神经的调节能力，提高迷走神经张力，降低交感神经活性，且均达到显著差异。腹式呼吸训练可用于治疗焦虑症。
The purpose of this study was twofold: (1) to study the function of autoriomic nervous system of patients with anxiety neurosis. (2) to approach the feasibility for treating anxiety neurosis with abdominal breathing.
To study the function of autonomic nervous system of patients with anxiety neurosis, heart rate variability (HRV) was analyzed in 40 patients with anxiety neurosis and in 40 healthy control. Using short梩erm (10 minutes)time domain measure of HRV, standard deviation of normal RR intervals(SDNN), percent of difference between adjacent normal RR intervals that was longer than or equal to 50ms(PNN50), root mean square successive difference between adjacent normals RR intervals(rMSSD),and the proportion of normal RK intervals whose number was the largest to al1 normal RR intervals(HRVI). The results showed that the mean of heart rate was higher in patients with anxiety neurosis than that in healthy control;SDNN, PNN50,rMSSD,HRVI were lower in patients with anxiety neurosis than that in healthy control. Thus, the study suggests thai anxiety neurotics have exaggerated sympathetic response, decreased vagal nervous activation and declined reactivity of autonomic nervous system.
To approach the feasibility for treating anxiety neurosis with abdominal breathing,we assigned 64 patients with anxiety neurosis to two groups:33 patients received respiration training
(experimental group),31 patients did not receive respiration training(control group).Heart rate variability(HRV) were measured before and after the experiment. Indexes were similar to that in before experiment. There was no difference in intial basel ine between the experimental group and the control group. The results showed that abdominal breathing led to changes in heart rate which were significantly decreased and SDNN,rMSSD, PNN50, HRVI which were significantly greater than those shown by the patients without respiration training. Thus, the study suggests that abdominal breathing may augment function of autonomic nervous system, increase vagal nervous reactivation and attenuate sympathetic activation.. Abdominal breathing could play an important role in treating the patients with anxiety neurosis.
为了研究焦虑症患者自主神经系统的功能特点，本研究对40名焦虑症患者和40名健康志愿者进行短时程(10分钟)心率变异性(HRV)分析，参数为平均心率，正常RR间期的标准差(SDNN)，相邻RR间期差的均方根(rMSSD)，相邻RR间期差异≥50毫秒的百分数(PNN50)以及心率变异系数(HRVⅠ)即RR间期总数目与占比例数最大的RR间期的数目之比。结果：焦虑症患者组平均心率高于正常对照组(P＜0.001)，焦虑症患者组SDNN、rMSSD、PNN50及HRVⅠ均低于正常对照组(P＜0.001)。提示：焦虑症患者自主神经功能下降，以迷走神经张力下降为主，交感神经活性相对亢进。
为了探讨腹式呼吸训练治疗焦虑症的可能性，本研究将64名焦虑症患者分为两组，33名患者接受腹式呼吸训练(实验组)，31名患者不接受腹式呼吸训练(控制组)，两组在实验前后对心率变异性进行极测，参数同上。实验组和控制组各参数的基线值无差异。结果：实验纽进行腹式呼吸训练后，平均心率下降，SDNN、rMSSD、PNN50及HRVⅠ均显著提高(P＜0.001，对照组各指标前后无显著性差别。提示：腹式呼吸训练能够提高焦虑症患者自主神经的调节能力，提高迷走神经张力，降低交感神经活性，且均达到显著差异。腹式呼吸训练可用于治疗焦虑症。
The purpose of this study was twofold: (1) to study the function of autoriomic nervous system of patients with anxiety neurosis. (2) to approach the feasibility for treating anxiety neurosis with abdominal breathing.
To study the function of autonomic nervous system of patients with anxiety neurosis, heart rate variability (HRV) was analyzed in 40 patients with anxiety neurosis and in 40 healthy control. Using short梩erm (10 minutes)time domain measure of HRV, standard deviation of normal RR intervals(SDNN), percent of difference between adjacent normal RR intervals that was longer than or equal to 50ms(PNN50), root mean square successive difference between adjacent normals RR intervals(rMSSD),and the proportion of normal RK intervals whose number was the largest to al1 normal RR intervals(HRVI). The results showed that the mean of heart rate was higher in patients with anxiety neurosis than that in healthy control;SDNN, PNN50,rMSSD,HRVI were lower in patients with anxiety neurosis than that in healthy control. Thus, the study suggests thai anxiety neurotics have exaggerated sympathetic response, decreased vagal nervous activation and declined reactivity of autonomic nervous system.
To approach the feasibility for treating anxiety neurosis with abdominal breathing,we assigned 64 patients with anxiety neurosis to two groups:33 patients received respiration training
(experimental group),31 patients did not receive respiration training(control group).Heart rate variability(HRV) were measured before and after the experiment. Indexes were similar to that in before experiment. There was no difference in intial basel ine between the experimental group and the control group. The results showed that abdominal breathing led to changes in heart rate which were significantly decreased and SDNN,rMSSD, PNN50, HRVI which were significantly greater than those shown by the patients without respiration training. Thus, the study suggests that abdominal breathing may augment function of autonomic nervous system, increase vagal nervous reactivation and attenuate sympathetic activation.. Abdominal breathing could play an important role in treating the patients with anxiety neurosis.
引文
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[6] 张松、张德山。焦虑的本质与矫正。许昌师专学报，1998，01，123。
[7] 徐韬园。现代精神医学。上海医科大学出版社。2000，07，第一版。
[8] 十二地区精神疾病流行学调查协作组。十二地区神经症流行学调查。中华精神科杂志，1996，19：87—91。
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[10] 张正林。神经症理论与实践。人民卫生出版社，2000，05，第一版。
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[12] 黄明生，刘协和。精神疾病诊疗手册。人民卫生出版社，2000，10，第一版。
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[14] Thayer JF ,Friedman HB, Borkovee TD .Autonomic characteristic of generalized anxiety disorder and worry .Biol psychiatry, 1996, 39:255-266。
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[20] K. T 斯托曼著，张燕云译。情绪心理学，辽宁人民出版社，1986，08．
[21] Willian Coryell, George Winokur(ed) . The Clinical Management of Anxiety Disorder。New York : Oxford University Press, 1991。
[22]Dayid A．Tomb编著，张勉译，精神病学，天津科技翻译出版公司出版．P99。
[23]徐韬园。现代精神医学。上海医科大学出版社。2000，07，第一版P334。
[24]张正林。神经症理论与实践。人民卫生出版社，2000，05，第一版P180。
[25]诺斯拉特·佩塞施基安著，白锡坤译。焦虑与恐惧，社会科学文献出版社，1998，02。
[26]李思特，张献共，郑少雄。惊恐障碍的呼吸系统特点及病理。国外医学精神病学分册，1997，02：92—95转引自
(1)Shiori T...:Acta Psychiatr Scand, 1996, 93: 83—86。
(2)Stein MB...:AM J Psychiatry, 1995, 152: 1168—1173。
[27]陈仲庚等。实验临床心理学，北大出版社，2001，09。
[28]朱熊兆。心理干预与免疫调节。国外医学精神病学分册，2000，03：182—185。
[29]亢万虎，毛莉君。情绪与免疫功能。国外医学精神病学分册，1994，04：210—213。
[30]冯大鹏。加强腹部呼吸对治疗功能性消化不良的效果和伦理学意义。中国康复医学伦理学，2000，03：16。
[31]冯焕渝，张文涛。两种腹式呼吸操治疗慢性阻塞性肺疾病的观察。中国康复医学杂志，1995，05：225．
[32]张书青。逆腹式呼吸提肛法治疗早期内痔105例报告．青海医药杂志，1998，09：47-48．
[33] 赵佐文。按摩逆腹式呼吸及物理疗法治疗结肠假性梗塞。现代康复，1999，12：1498。
[34] 马燕红，吴家荣。有氧训练、腹式呼吸和气功对轻度CDPD患者的康复作用。现代康复．2000，05。
[35] 高弘，孙晓莉。物理疗法、腹式呼吸训练治疗慢性阻塞性肺病。现代康复，2000，05。
[36] Malik M,Canmm AJ.Hcart ratc variability.Clin Cardiol,1990, 12:570-576。
[37] 郑军，张荣。心率变异性研究方法及其临床应用。中国循环杂志。1994，05：310—313。
[38] 吕爱华。心率变异性检测方法及临床应用价值。现代医学仪器与应用，1994，第六卷第四期。
[39] Morillo ,C.A. Klein, G.L ,et al. Time and Frequency domain analysis of heart rate variability during orthostatic stress in patients with neurally mediated-syncope American-Journal-of Cardioloty, 74(12) (1994)Dec. P151258—12627。
[40] Martin van Schijndel Control and Type A Behavior on Cardiovascular Responses。Psychophysiology Vol. 21 ,No, 5。
[41] L.J.M Mulder.。Measurement and analysis methods of heart rate and respiration for use in applied environmentd。Biological Psychology 34(1992) 205—236。
[42] Bigger JT .Respiratory sinus arrhythmia. Am J cardiol 1988 ,61:208。
[43] Malik M,Camm AJ. Heart rate variability. Clin Cardiol, 1990,J,1994,127:1376。
13:570-576
[44] 马景林等。心电图诊断与临床，科学技术出版社,1995,05,P119．
[45] E.M.Sokhadzc,and E.I.Shulman.The Approaches to Heart Rate Reepiralory Sinus Arrhythmia (RSA) Research and Application in Psychophysiology.in Biofeedbackand Self-Regulation, 1994,19(3) ,P297,.
[46] Gustavo A.Reyes Del paso.Juan Godoy,Jaime Vila.Self-Regulation of Rccpiratory Sinus Arrhythmia,in Biofccdback and Self-Regulation.,Vol.17 ,No,04,1992．
[47] Bigger JT,Kleiger RE ,Fleiss JL.et al .Components of heart rate variability measured during healing of acute myocardial infarction .Am J Cardiol ,1988 ,61:208-215．
[48] Kleiger RE ,Miller JP,Bigger JT ,et al .Decreased heart rate variability and its association with increasedmoortality after acute myocarsial infarction .Am J Cardiol ,1987,59 :256-262
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[50] Lombardi F,Sandrone G ,Pernpruner S ,et al .Heart rate variability as an index of sympathovagal interaction after acute myocardial infarction.Am J Cardiol,1987,60: 239．
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[58] Thayer JF, Friedman HB, Borkovee TD .Autonomic characteristic of generalized anxiety disorder and worry. Biol psychiatry, 1996,39:255-266。
[59] Hoehn-Saric R , Mcleod DR .The peripheral sympathetic nervous system:Its role in normal and pathologic anxiety. Psychiatric Clinics of North American. 1988,11(2):375-386。
[60] 李春波，吴文源，何康梅等。焦虑症患者心理生理学反应研究。
中国心理卫生杂志,2000,05: 557-340．
[61] Malik M.Camm.AJ.Heart rate variabi1ity.Clin Cardiol,1990． 15: 570-576,
[62] Klciger RE,Miller JP,Bigger JT,et al.Decreased heart rate variabi1ity and its association with increasedmoortality after acute myocarsial infarction.Am J Cardiol,1987,59:256-262．
[63] Guslavo A,Reyes Del Paso,Juan Godoy,andJaime Vila.Self-Regulaion of Respiratory Sinus Arrhythmia.in Biofeedback and Self-Regulal ion,Vol,17,No,4,1992．
[2] J．P 查普林、T、S克拉威克著，林芳译。心理学体系和理论，下册，135——138，商务出版社，1989。
[3] K．T 斯托曼著，张燕云译。情绪心理学，辽宁人民出版社，1986，08。
[4] 孟昭兰，人类情绪，上海人民出版社，1989，06。
[5] 郑希付，论焦虑。湖南师范大学社会科学学报，1997，01。
[6] 张松、张德山。焦虑的本质与矫正。许昌师专学报，1998，01，123。
[7] 徐韬园。现代精神医学。上海医科大学出版社。2000，07，第一版。
[8] 十二地区精神疾病流行学调查协作组。十二地区神经症流行学调查。中华精神科杂志，1996，19：87—91。
[9] 沈渔屯。精神病学。人民卫生出版社，1999，08，第三版。
[10] 张正林。神经症理论与实践。人民卫生出版社，2000，05，第一版。
[11] Schatzberg AF, Overview of anxiety disorder:Prevalence,biology, course, and treatment, J Clin Psychiatry 1991, 52 (7,suppl) ,5——9。
[12] 黄明生，刘协和。精神疾病诊疗手册。人民卫生出版社，2000，10，第一版。
[13] Klein E ,Cnaani E,Harel T, et al .Altered heart rate variability in panic disorder patients.Boil Psychiatry, 1995, 37: 18-24。
[14] Thayer JF ,Friedman HB, Borkovee TD .Autonomic characteristic of generalized anxiety disorder and worry .Biol psychiatry, 1996, 39:255-266。
[15] Hoehn-Saric R , Mcleod DR .The peripheral sympathetic nervous system: Its role in normal and pathologic anxiety. Psychiatric Clinics of North American. 1988 , 11(2): 375-386。
[16] Middleton A , Ashby M. Clinical recovery From panic disorder is associated with evidence of change in cardiovascular-regulation-Acta-Psychiatr-Scand. 1995, 91: 108-113o
[17] Bystritsky A ,Craske M, Maidenberg E, et al .Ambulatory monitoring of panic patient during regular activity: A-preliminary-report-Biol-Psychiatry . 1995, 38:684-689。
[18] 陈向一，杨德森。广泛性焦虑症的心理生理学特点。中国神经疾病杂志，1993，02：18—24。
[19] 李春波，吴文源，何康梅等。焦虑症患者心理生理学反应研究。中国心理卫生杂志，2000，05：337—340。
[20] K. T 斯托曼著，张燕云译。情绪心理学，辽宁人民出版社，1986，08．
[21] Willian Coryell, George Winokur(ed) . The Clinical Management of Anxiety Disorder。New York : Oxford University Press, 1991。
[22]Dayid A．Tomb编著，张勉译，精神病学，天津科技翻译出版公司出版．P99。
[23]徐韬园。现代精神医学。上海医科大学出版社。2000，07，第一版P334。
[24]张正林。神经症理论与实践。人民卫生出版社，2000，05，第一版P180。
[25]诺斯拉特·佩塞施基安著，白锡坤译。焦虑与恐惧，社会科学文献出版社，1998，02。
[26]李思特，张献共，郑少雄。惊恐障碍的呼吸系统特点及病理。国外医学精神病学分册，1997，02：92—95转引自
(1)Shiori T...:Acta Psychiatr Scand, 1996, 93: 83—86。
(2)Stein MB...:AM J Psychiatry, 1995, 152: 1168—1173。
[27]陈仲庚等。实验临床心理学，北大出版社，2001，09。
[28]朱熊兆。心理干预与免疫调节。国外医学精神病学分册，2000，03：182—185。
[29]亢万虎，毛莉君。情绪与免疫功能。国外医学精神病学分册，1994，04：210—213。
[30]冯大鹏。加强腹部呼吸对治疗功能性消化不良的效果和伦理学意义。中国康复医学伦理学，2000，03：16。
[31]冯焕渝，张文涛。两种腹式呼吸操治疗慢性阻塞性肺疾病的观察。中国康复医学杂志，1995，05：225．
[32]张书青。逆腹式呼吸提肛法治疗早期内痔105例报告．青海医药杂志，1998，09：47-48．
[33] 赵佐文。按摩逆腹式呼吸及物理疗法治疗结肠假性梗塞。现代康复，1999，12：1498。
[34] 马燕红，吴家荣。有氧训练、腹式呼吸和气功对轻度CDPD患者的康复作用。现代康复．2000，05。
[35] 高弘，孙晓莉。物理疗法、腹式呼吸训练治疗慢性阻塞性肺病。现代康复，2000，05。
[36] Malik M,Canmm AJ.Hcart ratc variability.Clin Cardiol,1990, 12:570-576。
[37] 郑军，张荣。心率变异性研究方法及其临床应用。中国循环杂志。1994，05：310—313。
[38] 吕爱华。心率变异性检测方法及临床应用价值。现代医学仪器与应用，1994，第六卷第四期。
[39] Morillo ,C.A. Klein, G.L ,et al. Time and Frequency domain analysis of heart rate variability during orthostatic stress in patients with neurally mediated-syncope American-Journal-of Cardioloty, 74(12) (1994)Dec. P151258—12627。
[40] Martin van Schijndel Control and Type A Behavior on Cardiovascular Responses。Psychophysiology Vol. 21 ,No, 5。
[41] L.J.M Mulder.。Measurement and analysis methods of heart rate and respiration for use in applied environmentd。Biological Psychology 34(1992) 205—236。
[42] Bigger JT .Respiratory sinus arrhythmia. Am J cardiol 1988 ,61:208。
[43] Malik M,Camm AJ. Heart rate variability. Clin Cardiol, 1990,J,1994,127:1376。
13:570-576
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[45] E.M.Sokhadzc,and E.I.Shulman.The Approaches to Heart Rate Reepiralory Sinus Arrhythmia (RSA) Research and Application in Psychophysiology.in Biofeedbackand Self-Regulation, 1994,19(3) ,P297,.
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