心律大師脈象分析

心律大師脈象分析

    除了量測血壓,HRV,心跳,及心律不整外,最新型的心律大師已兼具脈象分析(卽脈診儀)功能

    雖然心電圖機(ECG或EKG)也可以透過心電訊號量測HRV,但對於心臟打血及血液循環狀況都無法得知

    心律大師利用腕帶內獨家特製的生物感應器(美國,台灣,中國大陸專利),直接測得手橈動脈(卽中醫師把脈處)之血壓波完整的動脈血壓波型,蘊含有多重生理資料,包括心肌收縮打血,大動脈閥(Aortic Valve)開合,二尖瓣膜心閥閉鎖,及周邊血管阻力等

    圖一顯示年輕健康者之橈動脈血壓波型,從圖上可以看到血壓波型的重要特徵,包括大動脈閉啟開(左心室收縮打血開始),血流最速點(卽主波峰),大動脈閥關閉點(卽主波谷),重搏波(dicrotic wave;卽第二波峰),二尖瓣膜關閉點及第三小波等

    圖二顯示國際知名超音波儀器(USCOM)測得之大動脈血液流速圖與心律大師脈波圖之真時間對照. 結果顯示:當血液流速最高時,也是血壓值最高時;血液流速等於零發生於大動脈閥關閉點

    左心室收縮打血愈有力,大動脈閥開啟愈順暢(沒有阻塞或鈣化等),則主波的上昇支愈陡峭,主波高度愈高(卽強脈)

    周邊血管阻力愈低(下游血流順暢),則主波下降支愈陡峭

    以上兩點若都吻合,則會形成尖銳的主峰角;強而有力的主峰配上尖銳的主峰角,是良好脈象的特徵

    反之,左心室打血無力或大動脈閥老化,則主波上昇支緩慢,且容易形成弱脈

    周邊血管阻力大(血管緊張或下游血流不順暢),則主波下降支趨於緩慢

    以上兩點若吻合,則會形成鈍型的主峰角;弱脈兼具大主峰角是不良脈的特徵

    重搏波(卽第二主波)的形成係因為大動脈閥關閉後,血液迴流撞擊閥壁後與原血流合併後造成些微流速及血壓上升

    重搏波的波峰點位置之高低,代表大動脈閥關閉時之血壓,也因此反應周邊血管阻力

    心律大師將主峰角及重搏波峰點位置標準化後合併成為 ”血管緊張度”

    一般健康人血管緊張度低,為非弦脈或輕弦脈(如圖三及圖四)

    年紀大,心血管不健康,憂鬱症或肝病患者,常會呈現弦脈或重弦脈(如圖五)

    動脈硬化患者也會長期呈現弦脈或重弦脈; 動脈硬化是心臟麻痺(Cardiac Arrest) 及腦中風(Stroke)的主因之一

    另外中醫師常用的浮中沉,脈數,脈位,強弱脈,不規則脈等均有分析(見圖六)

使用心律大師之博碩士論文 整理 (更新 10/05)

參考：
使用心律大師之博碩士論文 整理 (更新 8/16)
使用心律大師之博碩士論文 整理 (更新 7/7)
使用心律大師之博碩士論文 整理 (更新)
使用心律大師之博碩士論文 整理
 
陸陸續續整理使用心律大師做研究完成的博士論文，到目前為止，已搜尋到34篇博碩士論文，有些論文從摘要看起來好像也是使用心律大師，但是因為沒看到論文全文或是在摘要或目次中寫明白，便不方便整理到表格內，表中所陳列出來的都是文中有寫到所使用的研究設備為心律大師的。

使用心律大師之博碩士論文 整理 (更新 8/16)

參考：
使用心律大師之博碩士論文 整理 (更新 7/7)
使用心律大師之博碩士論文 整理 (更新)
使用心律大師之博碩士論文 整理

使用心律大師做實驗完成的博碩士論文更新列表如下圖，論文名稱紅字部分為此次更新部分。

心律大師學術論文：Pulse Analysis System with a Novice Periodic Function Examination Method on Sepsis Survival Prediction

論文網址

Pulse Analysis System with a Novice Periodic Function Examination Method on Sepsis Survival Prediction

Abstract

This project proposes a pulse analysis system for doctors to diagnose their patients using their pulse signals. A novice and easy time-domain algorithm is applied to pulse signal for periodic function examination. Monitoring and modeling our body as a system with digitalized pulse signals is one of the linkages that we can find among Traditional Chinese Medicine (TCM), hemodynamics and modern Information Communication Technology (ICT). With the labeling of diseases or some modern Bio-markers, we are able to link pulse analysis, ICT and the latest medical science together. The proposed method is capable of calculating the instability of the pulse wave of subjects. After finding the starting point of each period in a periodic wave, we use set theory as the constraint to detect stable periodic wave. With normal heart rate checking and the variability of each period checking, our algorithm can detect whether the input signal is normal, stable and periodic. A coefficient that represents the instability is calculated by the average Standard Deviation (SD) of each period in the waveform. The proposed system helps the automation of pulse examination to select a proper segment for harmonic analysis. With the periodic function examination method, non-survival sepsis patients in Continuous Mandatory Ventilation (CMV) mode or Continuous Positive Airway Pressure (CPAP) mode can be significantly separated.

Keywords

eHealth; Bioinformatics; Traditional Chinese Medicine; Sepsis

心律大師學術論文：Heart rate variability and meditation with breath suspension

論文網址

Heart rate variability and meditation with breath suspension

Abstract

Increased high frequency and decreased low frequency powers in heart rate variability (HRV) have been found during various forms of meditation. However, advanced stage of meditation drew  less  attention  to  date.  We  aimed  at  exploring  HRV  characteristics  during  advanced meditation.  Heart  rate  (HR),  blood  pressures  (BP),  and  parameters  of  HRV  in  time  and  fre-quency  domains  of  a  single  meditator  were  collected  during  rest,  breath  meditation,  and  in advanced  meditative  stage  with  breath  suspension  in  10  meditative  sessions.  Friedman  test was  used  to  compare  the  variables  during  different  meditative  phases.  HR  and  BP  revealed significant differences during different meditative phases. Pair-wise comparison revealed that HR  decreased  continuously  and  significantly  while  meditation  advanced.  On  the  other  hand, none  of  HRV  parameters  reached  statistical  significance.  Our  findings  reveal  no  significant differences between different meditative phases in terms of HRV parameters, but HR and BP continuously  decrease  while  meditation  advances.  The  discrepancy  could  be  partially  attrib-uted to different meditative techniques.

Keywords:
Heart rate variability, Meditation, Breath suspension

心律大師學術論文：Web-based pulse analysis system for detection of acute kidney injury

論文網址

Web-based pulse analysis system for detection of acute kidney injury 

Abstract

The purpose of pulse analysis system is to provide a platform for researchers to analyze, share, and store patients' pulse data. Researchers can use the system to extract features through Fast Fourier Transform (FFT), harmonics, Ensemble Empirical Mode Decomposition (EEMD), and then take advantage of the former result to gather statistics and classify patients through two-sample t-test or paired-sample t-test. A group of researchers working in National Taiwan University Hospital (NTUH) have done an experiment to examine whether to find out acute kidney injury (AKI) through this system is feasible. The experimental subjects were patients who received open heart surgery. The experiment result shows that after surgery the mean value of harmonic 2 and 3 of patients with postoperative AKI from the proposed pulse analysis system decreased significantly, but not in patients without AKI. This system may have a potential for clinical use to detect AKI after open heart surgery and probably other disease. However, we need more cases to verify this experiment result because the number of AKI patients is limited.

Published in:
RF and Wireless Technologies for Biomedical and Healthcare Applications (IMWS-BIO), 2015 IEEE MTT-S 2015 International Microwave Workshop Series on

Date of Conference:
21-23 Sept. 2015

心律大師學術論文：Evaluation of blood stasis on tongue diagnosis associated with diabetes mellitus

論文網址

Evaluation of blood stasis on tongue diagnosis associated with diabetes mellitus
L Lo and P Hsu

BMC Complementary and Alternative Medicine
The official journal of the International Society for Complementary Medicine Research (ISCMR) 2012 12 (Suppl 1):P149

DOI: 10.1186/1472-6882-12-S1-P149

Published: 12 June 2012

Purpose

Diabetes mellitus is a metabolic disorder of hyperglycemia and is associated with the increase in cardiovascular diseases and other complications. In traditional Chinese medicine (TCM), examination of the tongue plays an important role in diagnosis. Tongue color, tongue characteristics (e.g. petechia) and sublingual collateral vessels indicate blood stasis status in TCM. The purpose of this study was to evaluate blood stasis on tongue image and Heart Rate Variability (HRV) associated with type 2 diabetes mellitus (DM).

Methods

A total of 119 subjects with DM were enrolled for tongue examination and HRV. A high resolution digital camera was used to record tongue images in a standard imaging environment. HRV and pulse wave analysis were performed by ANSWatch. A total of 51 DM patients attended the Quality-based Payment Program for Diabetes Care and received regular health education, examination, and follow-up.

心律大師學術論文：DIFFERENTIATING PHYSIOLOGICAL EFFECTS OF MIDTERM BREAK IN A PROLONGED ONLINE GAME PLAYING

論文網址
論文全文

DIFFERENTIATING PHYSIOLOGICAL EFFECTS OF MIDTERM BREAK IN A PROLONGED ONLINE GAME PLAYING

Tak-Yee Wong
Department of Medical Imaging, St. Martin De Porres Hospital, Chiayi, Taiwan
Department of Information Management, National Yunlin University of Science and Technology, Yunlin 640, Taiwan

Dong-Her Shih
Department of Information Management, National Yunlin University of Science and Technology, Yunlin 640, Taiwan

Sung-Yi Tsai
Department of Medical Imaging, St. Martin De Porres Hospital, Chiayi, Taiwan
Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan

Chiu-Yi Lee
Ministry of National Defense, 164 Boai Rd., Zhongzheng Dist., Taipei 100, Taiwan

Abstract

With the development of widespread Internet access, online game playing has become a popular event. As a result, more attention is being paid to the potentially negative physical and psychological effects on prolonged computer worker or online game player. To date, related physical problems that have been identified include fatigue, physical pain, insomnia, epileptic seizures, and even sudden death. Therefore, midterm break may be necessary for an online game player. This study tries to differentiate the physiological effects of two groups, with and without a midterm break, during a prolonged online game playing. Our experimental results showed that sympathetic system is overwhelming the parasympathetic nervous system significantly in group B without break, while it remains unchanged in group A. Due to the fight or flight response of the sympathetic system, participants with midterm break wanted to play more after event. Participants without break did not feel stressed after a continuous two hours' online game playing. These interesting findings may need further investigation in the future.

Keywords: Online game playing; Physiological parameters; Autonomic nervous system; Sympathetic system; Parasympathetic system

心律大師學術論文：Applying Usability Test to Find the Interface Design Principle of HRV Device for Senior Users

論文網址

Applying Usability Test to Find the Interface Design Principle of HRV Device for Senior Users

Hsin-Chang Lo, I-Jen Sung, Yu-Ting Lin

Abstract

Home use medical device industry prospers due to the ageing society. In both physiological and psychological domain, home use medical devices have received much attention in recent years. Seniors usually feel depressed or anxious because of losing health and living abilities. They can use the heart rate variability (HRV) device in analyzing their emotional response, however the interface of commercial HRV devices are not easy for them to operate. Therefore, the usability test of these devices was introduced for the senior users. Five senior user were recruited to conduct usability test of the two commercial HRV devices: ANSWatch (Taiwan Scientific Corp.) and CheckMyHeart Handheld HRV (DailyCare BioMedical Inc.) follow the typical operation task. Then the in-depth interview were conducted to find operational failure factors. All of senior users indicated that the serious failure factors are: “unable to understand English instructions” and “unable to determine the meaning of illustration”. Four of them indicated that the minor ones are: “no appropriate guide”; “text is too small”; and “layout is not appropriate”. Three of them indicated that “illustration surface reflection” is another problem. Therefore, we suggests that the home use HRV device interface design should consider principles such as (1) the language and icon properties, (2) step guides and text properties, (3) consistency of interface configuration, (4) color scheme to improve the operational satisfaction for the senior users.

Keywords

Usability test Home use medical device Heart rate variability

心律大師學術論文：Aromatherapy Benefits Autonomic Nervous System Regulation for Elementary School Faculty in Taiwan

論文網址

Evidence-Based Complementary and Alternative Medicine
Volume 2011 (2011), Article ID 946537, 7 pages
http://dx.doi.org/10.1155/2011/946537

Research Article
Aromatherapy Benefits Autonomic Nervous System Regulation for Elementary School Faculty in Taiwan

Kang-Ming Chang1,2 and Chuh-Wei Shen1,3

1, Department of Photonics and Communication Engineering, Asia University, Taichung 41354, Taiwan
2, Graduate Institute of Clinical Medical Science, China Medical University, Taichung 40402, Taiwan
3, Ming-Chien Elementary School of Nantou County, No. 220, Jhangnan Rd., Ming-Chien Township, Nantou County 55146, Taiwan

Abstract

Workplace stress-related illness is a serious issue, and consequently many stress reduction methods have been investigated. Aromatherapy is especially for populations that work under high stress. Elementary school teachers are a high-stress working population in Taiwan. In this study, fifty-four elementary school teachers were recruited to evaluate aromatherapy performance on stress reduction. Bergamot essential oil was used for aromatherapy spray for 10 minutes. Blood pressure and autonomic nervous system parameters were recorded 5 minutes before and after the application of the aroma spray. Results showed that there were significant decreases in blood pressure, heart rate, LF power percentage, and LF/HF while there were increases in heart rate variability and HF power percentage ( ) after application of the aromatherapy spray. Further analysis was investigated by dividing subjects into three background variables (position variables, age variables, gender variables) and anxiety degree groups. All parameters were significantly different for most subgroups, except for the substitute teachers and the light-anxiety group. Parasympathetic nervous system activation was measured after aromatherapy in this study. It encouraged further study for other stress working population by aromatherapy.

(略)

2.2. Experimental Procedures

Aromatherapy was conducted once a week. Physiological recordings were taken during the second week in the school’s health center. An Ultrasonic Ionizer Aromatherapy Diffuser was used for aroma evaporation (type YHL668/I, ultrasound frequency 2.5 MHz, Nature Creart Co. Ltd, made in Taiwan). 100% pure bergamot essential oil was used and diluted to 2%. Physiological parameters were recorded by an ANSWatch monitor (TS-0411 type, Taiwan Scientific Ltd., which has been approved by ISO 13485, and EU CE Mark). Each session was recorded for seven minutes. Average blood pressure and HRV parameters were shown on the panel of ANSWatch monitor. Detailed experimental procedures were as follows. IRB was approved by Asia University Medical Research Ethics committee.

(略)

心律大師學術論文：A Study of Relationship between Level of Internet Addiction and Physiological Effects when Surfing the Web

論文網址

A Study of Relationship between Level of Internet Addiction and Physiological Effects when Surfing the Web

William Hao-yu Shen
Nan-Jeon Institute of Technology

Jui-Chi Shen
National Kaohsiung University of Hospitality and Tourism

Dong-Her Shih
National Yunlin University of Science & Technology

Yi-Da Chu
National Yunlin University of Science & Technology

Abstract

The purpose of this study was to examine the physiological effects of computer worker when surfing the web. Twenty subjects are measured with physiological indices four times in the morning and afternoon. The results showed that higher level of Internet addiction is not as expected different with the lower level of Internet addiction. After surfing the web, there are significant differences in subjects' HR in the morning and afternoon. LF is significantly higher, as this time people are more spiritual and concentration in the morning. HF is higher in the afternoon, so people feel more relax or fatigue.

Keyword: Internet addiction, Physiological parameters, Web surfing

論文研討：急性心梗患者心率减速力与心率变异性

過勞猝死很危險，如果能有可以預防偵測的生理參數，將可以做好預防的工作。HRV在此領域也有一些研究，也許可以作為 Screen 的一項生理指標。

論文研討：Multiscale entropy and poincare plot-based analysis of pulse rate variability and heart rate variability of ICU patients

 論文網址：IEEE Xploer

Multiscale entropy and poincare plot-based analysis of pulse rate variability and heart rate variability of ICU patients
Rohit Parasnis; Akshay Pawar; M. Manivannan

2015 International Conference on Intelligent Informatics and Biomedical Sciences (ICIIBMS)
Year: 2015
Pages: 290 - 295, DOI: 10.1109/ICIIBMS.2015.7439531
IEEE Conference Publications

Abstract

It is now known that multiscale entropy has the potential to distinguish certain pathological time series clearly and reliably from the corresponding healthy series. However, the implications of this parameter for Heart Rate Variability (HRV) have not been studied extensively. Also, as reported by other studies, the Poincare plots of the R-R interval series of a human subject's ECG signal (which too function as a measure of HRV) could be more useful than the time-domain and frequency domain parameters of HRV for certain applications. Although the Poincare plots of healthy R-R interval series and corresponding PPG-based interval series have been investigated by many researchers, they do not seem to have been examined for unhealthy subjects. Our goal in this study has been to assess the extent to which PRV can substitute for HRV in the determination of these two nonlinear parameters. We perform multiscale entropy analysis (MSE) on Pulse Rate Variability (PRV) and HRV of 20 ICU patients. We also obtain Poincare plots associated with PRV from four PPG-based techniques and those characterizing HRV from the standard R-R interval technique. We then compare the resulting PRV data sets with their HRV counterparts. We observe that none of the PPG-based methods displays a satisfactory statistical agreement or even an acceptable statistical correlation with the standard ECG-based technique. Hence we conclude that as of now, one cannot rely on PRV as a convenient alternative to estimate the MSE values and Poincare plots of HRV. However, further investigation on the lines suggested in the paper might yield fruitful insights.

論文研討：A Combined fMRI and Heart Rate Variability Paradigm for Assessment of Central Autonomic Modulation

論文網址：IEEE Xplore

A Combined fMRI and Heart Rate Variability Paradigm for Assessment of Central Autonomic Modulation
Riccardo Barbieri; Giulia Conti; Rupali Dhond; Emery N. Brown; Vitaly Napadow

2007 3rd International IEEE/EMBS Conference on Neural Engineering
Year: 2007
Pages: 615 - 618, DOI: 10.1109/CNE.2007.369747
IEEE Conference Publications


Abstract

While the central autonomic network (CAN) has been adequately defined in animal models, data from the human have been lacking. In this study, we correlated cardiac-gated fMRI data with continuous-time heart rate variability (HRV) assessment in order to estimate central autonomic processing in response to a dynamic grip task. The electrocardiogram (ECG) was collected simultaneously with fMRI, and was analyzed with a new point process adaptive filter algorithm for evaluation of HRV indices reflecting time-varying dynamics of autonomic modulation. These were correlated with fMRI signal intensity using a general linear model and subsequent analysis of covariance. Our combined HRV-fMRI data analysis suggests that fMRI activity in several brain regions, including the hypothalamus, parabrachial nucleus, periaqueductal gray, amygdala, and posterior insula, demonstrated significant correlation with parasympathetic tone assessed by HRV high frequency (HF) power. This study demonstrates that inter-subject variability in brain response to an exercise task may help explain the natural variability in autonomic response, as assessed by HRV analysis

論文研討：Cerebral cortex and sub-cortex lateralization in cardiovascular regulation: Correlations of BOLD fMRI and heart rate variability

論文網址：IEEE Xplore


Cerebral cortex and sub-cortex lateralization in cardiovascular regulation: Correlations of BOLD fMRI and heart rate variability

P. Kuoppa; E. Niskanen; P. Karjalainen; M. P. Tarvainen

2012 Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Year: 2012
Pages: 3412 - 3415, DOI: 10.1109/EMBC.2012.6346698
IEEE Conference Publications

Abstract

The role of cerebral cortex in cardiovascular regulation has not yet been mapped in detail. Especially the lateralization of different regions that are connected to cardiovascular modulation is still unknown. In this study we used simultaneously measured electrocardiography (ECG) and blood oxygen level dependent (BOLD) fMRI to examine the correlation of cerebral cortex and sub-cortex activation and heart rate variability parameters. Correlations were calculated for 11 subjects. Regions of interest (ROIs) were predefined from observations made in previous studies. Lateralization was studied by forming ratios of left and right hemisphere activations in ROIs and calculating correlations of these to heart rate variability (HRV) parameters. Statistically significant correlations were found in every ROI.

認識自律神經失調

資料來源：臺安醫院



認識自律神經失調

一、案例

李小姐，三十八歲，忽冷忽熱，晚上睡覺會冒汗、腸胃道不適，經常便秘或是胃酸逆流。另外她長期頭暈、肌肉酸緊、耳鳴、晚上難以入眠，白天卻又很疲 倦。經過耳鼻喉科檢查及神經內科檢查均顯示正常。三個月前開車時，突然出現心跳加快、胸悶、呼吸困難，覺得自己快要窒息，抽血及心電圖檢查都正常。這樣的 狀況日後無預期地發生了兩三次，每次都是在密閉空間。不斷反覆做檢查，試圖找出病因，不過結果都顯示正常。轉介精神科，診斷為恐慌症及廣泛性焦慮症。


二、何謂自律神經失調

自律神經失調是用來形容一群難以用生理的原因去解釋的身體症狀。在精神科裡面，它與下列診斷相關：身體化疾患、未分化型身體疾患、疼痛疾患、恐慌 症、廣泛性焦慮症、轉化症、解離症、慮病症、強迫症、心理因素影響或造成的醫學狀況、戲劇性人格、強迫性人格等。典型的症狀包括：頭痛、頭暈、胸悶、心 悸、腸胃道不適、呼吸急促、冒汗、手腳發抖、肩頸肌肉酸緊、耳鳴、手腳發麻。症狀各式各樣，但這些診斷的共同特點是個案患有一些很困擾的非特異性身體的症 狀，不斷地去做檢查都找不出病因。但是找不出病因，並不代表沒有原因，而是這些症狀大都跟心理壓力有關。

甚至有些生理的疾病，現在都已被認為跟心理因素是密切相關的：包括高血壓、氣喘、胃潰瘍、異位性皮膚炎、發炎性腸炎、甲狀腺機能亢進、風濕性關節炎、腸躁症等。

三、自律神經失調的成因

生理會影響心理，當然心理也會影響生理。很多疾病的產生，除了先天體質跟環境的交互作用之外，心理其實扮演很大的角色。首先我們要先瞭解壓力反應。 當我們遇到急性壓力時，我們的大腦的杏仁核會先偵測到危險的刺激，透過交感神經系統發射訊號給我們的腎上腺髓質系統，因此腎上腺就會分泌腎上腺素及正腎上 腺素，讓我們的血壓上升、心跳加快、肌肉收縮、腸胃道蠕動變慢，產生打或跑的反應，以應付外來的壓力。這是生物體求生存的一種本能及保護的機制。但是，一 旦大腦不斷地偵測到壓力，就會進入慢性壓力的模式。這時候，我們的腎上腺皮質就會接手，分泌體內壓力荷爾蒙，就是所謂類固醇。類固醇會降低免疫力。因此當 我們壓力大時，比較容易感冒。另外壓力荷爾蒙會不斷告訴大腦，現在還是處在危險的狀態。因此大腦會通知身體儲存脂肪以備不時之需。難怪，長期在慢性壓力之 下的人，常會有厚厚一層的腰圍脂肪。特別是內臟脂肪跟心血管疾病及糖尿病相關。另外，大腦長期在壓力荷爾蒙的作用下，神經細胞會受損。一旦大腦生病了，我 們的自律神經系統就會失調，憂鬱、焦慮及身體其他的疾病就會隨之而來。自律神經系統分為交感神經及副交感神經，交感神經會讓我們處在亢奮的狀態，好讓我們 應付壓力；副交感神經則讓我們處在放鬆的狀態，可以讓細胞休息獲得養分。這套神經系統不是我們意識可以控制的，但它主管我們的呼吸、心跳及腸胃道蠕動。因 此自律神經失調，最常見的症狀都跟這幾個器官系統有關。

除了外在壓力之外，另一種叫做內在壓力。每個人都會有內在的心理衝突，我們會有憤怒及性的慾望，這些都來自本我（Id）。但是自我（Ego）常常必 須壓抑這樣的慾望，因為我們內在的超我（Superego）常不允許這樣的慾望出來。壓抑成功的話，就不會有症狀，但是如果壓抑失敗的話，就會出現症狀。 這叫做內在衝突，既想要滿足慾望，但是又害怕實現自己慾望，因此就卡住了。A型人格，事事要求完美的人，就常讓自己處在高度壓力的狀態以及高度壓抑的人 格，比如說敢怒不敢言、忍氣吞聲的人，都比較會產生所謂的內在壓力。

四、診斷及治療

自律神經失調的診斷，必須經過詳細的問診，並安排相關檢查以排除生理的疾病。既然心理扮演很重要的角色，因此問診時，醫師會詳細詢問現在生活所遭遇 的外在及內在壓力，及其與症狀之間的關聯性。另外心率變異性是目前心身醫學科常用來偵測自律神經失調的檢查。心率會隨著身體所感受的壓力狀態透過自律神經 做出快或慢的調節。心率變異性愈好的人，心臟的彈性度越好，自律神經的調節越平衡。

自律神經失調既然被認為跟壓力有關，因此壓力管理是很重要的。如果是外在壓力，就要去思考有沒有可能改變壓力源。如果壓力源的改變是有限的，那就要 去反求諸己，改變自己對外在壓力的認知。另外學習腹式呼吸及冥想可以幫助放鬆。如果壓力是來自內在的，就要瞭解自己內在的心理衝突，將壓抑的能量轉化或昇 華，這有時需要透過心理治療來幫忙。另外，最好的治療就是養成固定的有氧運動習慣。運動可以讓大腦健康、讓肌肉放鬆、也可以轉移壓抑的能量，對身體及心理 有莫大的幫助。切記，要去享受運動完之後的舒暢感覺，而不是讓運動成為另一種心理壓力。

如果自律神經失調已經嚴重到疾病的診斷時，才會考慮藥物治療。目前常用的抗憂鬱劑及鎮定劑都有改善症狀的效果。一般而言，抗憂鬱劑的服用需要至少半 年到一年的時間。鎮定劑則是短期服用。藥物的療效其實只有五成到六成的效果。所以自我信念的力量更是重要的。相信自己會好，其實就已經好一大半了。

總而言之，我們的自我承受三方壓力：來自外在現實的壓力、來自超我的要求及來自本我的慾望。這三方出現任何一方失衡時，我們就會出現心身的症狀（圖一）。瞭解自己的壓力根源，尋求專業的協助，才是上策。



作者：臺安醫院心身醫學科暨精神科主治醫師　曾冠喬
出處：臺安醫訊第166期

 

延伸閱讀

交感神經系統與副交感神經系統之交互作用 Interaction between the sympathetic nervous system and the parasympathetic nervous system  

牙醫師也推薦量測自律神經 

心跳變異性與自律神經的關係. Relations of heart rate variability (HRV) and autonomic nervous system (ANS).  

什麼是自律神經失調 ( Dysautonomia )  甚麼是自律神經 Introduction of ANS

HRV parameters, 心跳變異性參數 

HRV Time domain analysis and Frequency domain analysis 

自律神經系統, Autonomic Nerve System, ANS  

 

認識二尖瓣脫垂

資料來源：臺安醫院

二尖瓣膜脫垂

現在社會，因壓力越來越大，因而越來越多人罹患各種心臟疾病，不過多半可以服藥控制，可是二尖瓣膜脫垂，在我的經驗當中，並不是每個醫生都注意到的疾病，卻有許多人都有著二尖瓣膜脫垂的困擾，這樣的情形，更應該讓大家多認識瓣膜脫垂，好向醫生說出自己的困擾，及早治療！


二尖瓣是位於心臟當中左心房和左心室之間的一組瓣膜，功能主要是控制血液的流向，當我們左心室舒張時，瓣膜便會打開，讓左心房的血液得以灌注到左心 室，而在左心室收縮時，瓣膜則會緊閉，使左心室將血液繼續往前至主動脈進而供應全身的組織。二尖瓣脫垂就是，這兩個瓣膜，或是其中之一稍為寬了些，當瓣膜 關閉時，瓣膜會突出到另一邊（左心房），若稍為嚴重點，甚至可能會讓這扇門關的不夠緊，無法完全的閉合，就會造成血液逆流的情形。

二尖瓣脫垂在西方歐美先進國家是常見的先天性瓣膜異常，同時也是造成非缺血性二尖瓣逆流主要原因之一。通常二尖瓣脫垂的預後非常好，只有在極少數的 患者身上會發生極嚴重的併發症：包括感染性心內膜炎、重度二尖瓣逆流併心臟衰竭以及猝死，而且心臟超音波檢查對於診斷二尖瓣脫垂，以及預測發生併發症的高 危險型病人是一項非常方便和準確的工作。此病症是如何被發現的呢？在1960年左右，Dr. Barlow 首先利用左心室造影發現「激」（click）雜音與心室收縮末期的二尖瓣閉合有關；隨後Dr.Criley 便將這種有「激」（click）雜音的二尖瓣命名為二尖瓣脫垂。

一般而言，在二維胸前心臟超音波檢查下，利用胸骨旁長軸影像診斷二尖瓣脫垂較為準確。在此影像下不管有無二尖瓣葉片增厚，如有單葉或雙葉的二尖瓣葉 片距離二尖瓣環超過2mm 以上才可診斷是二尖瓣脫垂。據此，二尖瓣脫垂發生率大約為2-7%（平均5%），女性為男性兩倍。二尖瓣脫垂的診斷最好是根據病史、理學檢查、心音圖及心 臟超音波作一綜合判斷，尤其是聽診。用較精良的心臟科聽診器可聽出較微小的心音變化。在疾病早期，病患可能只是一輕微的「激」（click）雜音。隨著瓣膜變化日益嚴重，病患會產生一收縮期雜音，可同時合併有或無「激」（click）雜音。

利用體位的改變來幫助聽診是極為重要，臨床醫師不可忽略。例如「激」雜（click）音在病患站立時會靠近第一心音，左側躺時聽診較容易，站立時收 縮期雜音會變大聲及時間較長等等。大部份二尖瓣脫垂病人心電圖都是正常，少部份有ST-T 變化。胸部X 光檢查則大多正常。若臨床上聽診，超音波顯示瓣膜由左心室脫垂到左心房，加上心音圖，則診斷的確立應無問題。而心臟超音波為普遍及準確診斷工具，主要可以 判斷瓣膜脫垂的嚴重程度及整體心臟功能的好壞，故一般門診上常使用之。

「二尖瓣脫垂症侯群」為一臨床病徵，病患會有不同程度的新陳代謝、神經內分泌及自律神經異常，病患的臨床症狀往往不能用瓣膜異常來解釋。二尖瓣脫垂 病患有時會合併有心臟電氣生理上的變化，例如：多了不正常的傳導電線。自律神經（為交感及副交感神經統稱）失調、交感神經張力異常、腎上腺荷爾蒙受影響、 或心臟血流動力學的影響及漸進性的二尖瓣血液回流等情形會使心房及心室功能不妥而產生心房顫動，甚至致命的心室頻脈。必要時須求診心臟內科門診。

此外，病患往往有心悸、胸痛、胸悶不適、易倦怠、呼吸不順、倦怠、胃口差、頭暈或暈倒、心律不整、運動能力較差、坐起來頭暈、胸前或者頸部有異物哽 住，甚至有神經心理症狀，由以上可見其症狀之多樣化，大部份發病年齡為二十至三十歲，若症狀明顯則顯示病人的自律神經在亢奮狀態。

治療方面，由於一般非專業心臟科醫師常常誤診病人為心肌缺氧或心理疾病，或中醫說的心臟無力，往往使病人有到處奔波之苦。做了一大堆檢查卻得不到正 確診斷，耗費大量醫療資源及使用不恰當藥物，使某些病人受盡折磨。所以專業診斷，詳細的了解病情，心內膜炎的預防會使病情改變大半。二尖瓣脫垂的女性對體 液變化較敏感，故在月經來時症狀會加劇，注意水分補充即可。一些對心臟有刺激性的東西如咖啡因、香煙、酒精或含腎上腺賀爾蒙藥並不適宜。短期的小量乙型阻 斷劑Inderal（恩達樂）控制自律神經以及少許輕微、溫和的鎮靜劑可使90%以上的病人症狀消失或緩解。

最後，二尖瓣脫垂患者生活上應注意下列事項：

1. 了解自己的病況，不要被突發的症狀嚇到，因過度恐慌會使心律不整更嚴重。
2. 規律的生活，適度的休息，不熬夜→避免睡眠不足。
3. 運動方面不需特別限制，只要體力能負荷的活動皆可參與。
4. 避免刺激性飲料，如：濃茶、濃咖啡。
5. 若遇拔牙或外科小手術…等必須告知醫師，給予適當的藥物，以預防心內膜炎。
6. 依照醫師指示，儲備適量的藥物，於病況發作時可以立即服用。
7. 依照醫師指示定期回醫院做超音波檢查（約1-2年複查一次）。

作者：臺安醫院心臟內科主治醫師　林東君
出處：臺安醫訊第149期


延伸閱讀：

二尖瓣膜閉鎖不全 (Mitral Valve Prolapse, MVP) 的影響

二尖瓣膜閉鎖不全 (Mitral Valve Prolapse, MVP) 的連續血壓波偵測

論文研討：A combined HRV-fMRI approach to assess cortical control of cardiovagal modulation by motion sickness

論文網址：
A combined HRV-fMRI approach to assess cortical control of cardiovagal modulation by motion sickness

結合 fMRI 與 HRV 研究暈車的心臟迷走神經的調節。

Conf Proc IEEE Eng Med Biol Soc. Author manuscript; available in PMC 2012 Feb 8.
Published in final edited form as:
Conf Proc IEEE Eng Med Biol Soc. 2011 Aug; 2011: 2825–2828.
doi:  10.1109/IEMBS.2011.6090781

A combined HRV-fMRI approach to assess cortical control of cardiovagal modulation by motion sickness

J Kim, V Napadow, B Kuo, and R Barbieri, Senior Member, IEEE

Abstract

Nausea is a commonly occurring symptom typified by epigastric discomfort with the urge to vomit. To date, the brain circuitry underlying the autonomic nervous system response to nausea has not been fully understood. Functional MRI (fMRI), together with a point process adaptive recursive algorithm for computation of the high-frequency (HF) index of heart rate variability (HRV) was combined to evaluate the brain circuitry underlying autonomic nervous system response to nausea. Alone, the point process analysis revealed increasing sympathetic and decreasing parasympathetic response during nausea with significant increased heart rate (HR) and decreased HF. The combined HRV-fMRI analysis demonstrated that the fMRI signal in the medial prefrontal cortex (MPFC) and pregenual anterior cingulate cortex (pgACC), regions of higher cortical functions and emotion showed a negative correlation at the baseline and a positive correlation during nausea. Overall, our findings confirm a sympathovagal shift (toward sympathetic) during nausea, which was related to brain activity in regions associated with emotion and higher cognitive function.

論文研討：Research on Heart Rate Variability (HRV) in Acute Ischemic Stroke

論文網址：
Research on Heart Rate Variability (HRV) in Acute Ischemic Stroke

研究心率變異性（HRV）在急性缺血性腦中風的變化，並使用 CT 與 MRI 來做確認。

《Heilongjiang Medical Journal》 2009-05

Research on Heart Rate Variability (HRV) in Acute Ischemic Stroke

WU Yu-ling (Department of Neurology,Huli Hospital of Xiamen City,Xiamen 361006,China) 

Objective To explore the differential effects of stroke localization on autonomic function parameters assessed by HRV and study the circadian fluctuation of HRV in acute phase of ischemic stroke. Methods 24 h HRV of 70 stroke patients were recorded and analyzed in acute stage (5 d and 5 w) to contract with 50 age-and sex-matched health as control groups. Clinical location of hemispheric brain infarction were verified by CT or MRI. Results (1) In acute phase of ischemic stroke (5 d) all index of heart rate variability had significantly decreased (P0.01),and they all recovered after 5 weeks (P0.05). (2)The index in Patients with right cerebral infarction had significantly lower than that in left localization (P0.05). The index of right insular lobe was the lowest in all groups. Conclusion Acute cerebral infarction significantly decreased heart rate variability as a result of cardiovascular autonomic dysregulation. The decreased autonomic function has reversible tendency following the time went by.

【Key Words】： Cerebral infarction Heart rate variability Autonomic nerve function

論文研討：Heart rate variability and brain imaging of schizophrenic patients

論文研討：MRI Acupuncture Research on Point Specificity

論文網址：
MRI Acupuncture Research on Point Specificity 


New acupuncture research concludes that, “Recent evidence shows that stimulation of different points on the body causes distinct responses in hemodynamic, fMRI and central neural electrophysiological responses.” The researchers note that fMRI and laboratory studies demonstrate unique changes within the body when specific acupuncture points are stimulated. The study demonstrates that specific acupuncture points have specific biophysiological effects. As a result, the researchers suggest further research to investigate these measurable, quantifiable and objective phenomena.

Researchers from the Department of Medicine at the University of California, Irvine, examined the specific effects of needling different acupuncture points as compared with stimulation of non-acupuncture points and placebo simulated stimulation. The researchers note that “... many well-controlled studies do support the principle of point specificity.” They cite as example multiple studies of cardiovascular disease and note that real acupuncture points “elicit(s) significantly greater responses than stimulation of both non-acupoints and inactive acupoints.” They also conclude that stimulation of different acupoints “produces differential input to regions of the brain that regulate sympathetic outflow and cardiovascular function.”

The researchers note that a hemodynamic study of acupoint P6 showed that this acupuncture point “decreased heart rate and increased the high-frequency HRV index of cardiac vagal modulation….” A sham acupoint (a point not located on a traditional acupoint location) was able to decrease the heart rate but did not change the vagal outflow as did P6. These differing mechanisms suggest that sham acupuncture studies may obscure the true medical benefits of acupuncture. In the case of P6 stimulation, only the true acupuncture point increased the high-frequency HRV index. HRV (heart rate variability) is the variance in time interval between heart beats. Reduced HRV is linked to mortality after myocardial infarction and a lowering of HRV is also linked to congestive heart failure, diabetic neuropathy and low survival rates in premature babies. Both true and sham acupuncture decrease heart rates but only true acupuncture increases HRV. Examination of other true acupuncture points (across numerous studies) compared with non-acupuncture points and non-relevant acupuncture points confirms that hemodynamic responses are specific to exact acupuncture points and that true acupoints elicit sympathoexcitatory responses relevant to their traditional medical indications.

Neurological investigations support the specificity of acupuncture points. The researchers examined MRI studies of the brain and note that “stimulation of different sets of acupoints leads to disease-specific neuronal responses, even when acupoints are located within the same spinal segment.” The researchers also note, “The point-specific actions resulting from stimulation of different acupoints in controlled laboratory trials confirm that needling different points on the body produces more than just placebo responses, given that placebo acupuncture is not associated with differential or acupoint-specific responses in anesthetized animals.”

Reference:
 
Point specificity in acupuncture. Chinese Medicine 2012, 7:4 doi:10.1186/1749-8546-7-4. Emma M Choi, Fang Jiang, John C Longhurst.
 
Susan Samueli Center for Integrative Medicine, Department of Medicine, School of Medicine, University of California, Irvine CA.
 
Medical Science, School of Medicine, University of California, Irvine, CA.

交感神經系統與副交感神經系統之交互作用 Interaction between the sympathetic nervous system and the parasympathetic nervous system

 (原文發表於 2016/06/19, 新增表格於 2016/07/26) 

交感神經系統與副交感神經系統之交互作用介紹如下：

就生理學而言,交感神經負責因應人體緊張,恐懼,戰鬥,或逃難期間之生理需求,而副交感神經則主宰能量的保存及重建,兩者的目標無異,都是為了維續生命. 從表一可以看出,交感神經受到刺激會造成心跳加快,瞳孔放大,支氣管放鬆,肝醣轉換成葡萄糖,新陳代謝加快,腦活動增強等強化活動力及消耗體能之反應; 反之副交感神經受到刺激則引起心跳減慢,瞳孔縮小,支氣管收縮,肝醣合成,消化及吸收等保存及重建能量之反應. 白天期間因應工作及活動力需求,交感成為主導,到了夜晚休息時,副交感又成為主宰,兩者之影響是相互擷抗的,卻又需回應體內及體外之刺激而持續性的改變及維持平衡.

我們可以用心跳為例,來探討自律神經平衡的重要性. 控制心跳之機制主要有兩個,一個是心肌肉之竇房結(Sino-atrial Node, SA Node),如果沒有外力的作用,它會以自己的自然節奏震盪,另一個則是自律神經系統,它負責依內需及外需調節心率,如果把心跳比喻為開車,則交感神經為油門,而副交感神經是剎車. 值得注意的是,自然心跳頻率高於正常心跳(每分鐘72次),若副交感神經失去調解功能,則有如開車時剎車失靈,比起油門不足(交感神經興奮功能不佳)更為嚴重. 不少心血管疾病病患因突然心跳劇烈加速而致死,便是這個原因.

此外,現代人的生活形式多半伴隨著緊張壓力,常會造成交感神經過盛,必須靠副交感神經舒緩及復原. 從前一篇表一可以得知,自律神經系統負責內臟器官,內分泌,外分泌,及排泄系統之正常運作與維持,當這些器官及系統之功能發生異常時,自律神經系統便緊急啟動,進行調整. 調整的方式包括心跳加速或減緩,肺部支氣管收縮或舒張,血管(動脈及靜脈)收縮或舒張,血流重新分配(例如將血液送至傷害區),新陳代謝速率調整等,此時自律神經的活性會較正常狀態為高,而且交感與副交感不一定處於平衡狀態.

由以上討論,我們可以體認到自律神經活性異常現象,常是體內器官或腺體異常之徵兆,而非自律神經本身組織及功能失常. 例如病患因腦部血管阻塞,常有缺氧及頭痛現象,自律神經此時會局部性擴充腦血管,加快心跳及心肌收縮力,但若是腦部突然嚴重缺氧(可能造成腦細胞壞死時),自律神經立即令病患暈倒. 這些都是自律神經發揮功能的正常現象.

另一方面,自律神經的功能無法配合身體需求時,則必需檢討其根源為體內器官嚴重異常,或自律神經系統之組織結構病變. 例如有人坐久突然站起時會眩暈(或爬樓梯時),這可能是自律神經功能不足所致,因為人體從坐姿變為站姿時,交感神經必需立即收縮下半身之血管,將血液送至腦部及上半身. 正常人有此健全機制,因此不會有眩暈現象,但具有眩暈現象的人,可能是腦血管異常(即使交感神經正常,甚至發揮至極限也仍不足),或是自律神經組織病變. 另一個結論是,藉由量測自律神經系統之活性及其平衡狀態,常可預先得知體內器官及分泌系統之疾病徵兆.

心律大師 即時測試模式 (Biofeedback)

心律大師即時測試模式

<範例1> 先坐下再站起來 (每十秒鐘在LCD上面報告一次HR及HRV; 專業頂尖型可在PC上看到脈波,R-R波波間距, HRV,及HR之圖型)

從上圖及表格,站姿比起坐姿需要更多的能量,通常副交感會撤退,造成心跳加快及自律神經總活性HRV下降. 根據臨床經驗,從坐姿到站姿,心跳至少要加3(上例從91升為94.5),否則表示自律神經失調.

<範例2> 先正常呼吸再丹田深呼吸

從以上圖型得知,從正常呼吸到丹田深呼吸,會啟動副交感,造成HRV增加(上例從11到28),深呼吸越完整,HRV增加越多,此時脈波及R-R波波間距也會呈波浪,使用者一邊做丹田深呼吸,一邊觀察自己的生理參數變化,達到”生物回饋Bio-feedback”的效果.

即時心跳及HRV之功能還可用來監控:

-喝咖啡,茶葉,人參等之即時效應
-聽音樂之即時效應
-心理輔導之即時效應
-測謊

 

英國牛津大學 陳惟華 博士醫師 在TVBS健康兩點靈節目中介紹自律神經檢測

英國牛津大學 陳惟華 博士醫師 在TVBS健康兩點靈節目中介紹自律神經檢測，使用心律大師。

自律神經失調3檢測 - 英國牛津大學 陳惟華 博士醫師

心律不整 (Cardiac Arrhythmia)

心律大師除了量測血壓與自律神經功能外，另一個特色是分析心律不整。

廣泛的心律不整 (Cardiac Arrhythmia) 定義指的是心電不正常活動，包括心跳太快(每分鐘120以上)、心跳太慢(每分鐘50以下)、及不規則心跳。

最常見的不規則心跳是提前(Premature Contraction)、延後(Delayed Contraction)、少跳(Skipped Heartbeat)、及多跳(Extra Systole)，有時這些現象會合併或重複發生(見下圖)。

正常的心電活動，應以心竇(Sinus Node)為源頭，產生有節奏的放電。但種種原因會造成其它部份的心肌細胞也自行產生放電活動，造成心律不整。

以不正常放電源來區分，最常見的心律不整是下心室提前收縮(Premature Ventricular Contraction, PVC)，其次是上心房提前收縮((Premature Atrial Contraction, PAC)。

即使健康人偶而也會發生心律不整(約20~30%)，但先天或後天心血管疾病的人發生的頻率較高。

大部分的PAC或PVC都不需以藥物治療，但心律不整為心臟負荷過重或自律神經失調的警訊，從預防醫學的觀點來看，絕不可忽視，畢竟許多猝死者發病前都伴隨心律不整。

除了心血管及自律神經疾病外，已知會造成心律不整的原因包括：吸毒、喝酒、抽菸、過勞、壓力、焦慮、咖啡因、巧可力、失眠、失水、運動過度及電解質(鈉、鉀、鈣等)不平衡。

少數嚴重心律不整的病患需要藥物(如血管擴充劑、交感阻斷劑(Beta Blocker)等)或醫療器材(如心律調整器)加以治療，但大部分的人只要在生活及飲食上加以調整，即可改善或去除心律不整。

二尖瓣膜閉鎖不全 (Mitral Valve Prolapse, MVP) 的影響

雖然絕大多數患有MVP的人不須任何治療，但由於MVP常伴隨著心律不整、自律神經失調、或焦慮/恐慌症，因此經常監控是必要的。
如果有下列症狀，便要懷疑自己是否有MVP，建議進一步請醫生檢查
        常感頭暈或疲倦
        運動或休息時胸痛或喘不過氣
        覺得心跳突然增快或停止
        曾暈倒過
        焦慮或恐慌

MVP罹患率各國估計在5-15%之間，女性略多於男性，遺傳因素最大。
若病情不嚴重，只要飲食改善(不可喝咖啡、茶、可樂或吃巧克力等含咖啡因之食物，少吃甜食，多喝水)，運動鍛練(尤其是有氧運動)及情緒管理，即可保持或改善。
病情嚴重者，醫生會建議藥物治療或開刀。
心律大師除了可檢測自律神經功能(HRV相關參數)及心律不整外，還可藉脈波分析觀察不正常的血流活動。

二尖瓣膜閉鎖不全 (Mitral Valve Prolapse, MVP) 的連續血壓波偵測

從實際的臨床病例，發現心律大師脈象診斷功能可以檢測二尖瓣膜閉鎖不全(Mitral Valve Prolapse, MVP)如下圖：

二尖瓣膜是介於上左心房及下左心室之間的心閥，當左心房的血往下注入左心室時，它的兩個葉片必需旋開;當左心室收縮打血出去時，兩個葉片必需關閉，左心室打血是供應身體血液的主要來源。

當二尖瓣膜的兩個葉片過於肥厚、長得不正、或脫垂時，便無法正常的旋開或關閉，情況嚴重時左心室的血液會在心肌收縮時迴流(Regurgitation)至左心房。


此迴流會反映在動脈波形上，所以連續血壓波的量測可以看到二尖瓣膜閉鎖不全的現象，因為這是屬於壓力的機械波，所以心電圖是看不到但是血壓的壓力波卻可以看到，目前臨床上關於二尖瓣膜閉鎖不全一般是使用聽診或是超音波量測，而聽診取決於醫師的聽診經驗與技術，而超音波檢測一方面較為昂貴，一方面也與解析度有關，而連續血壓波的偵測是一種既客觀又簡便的方式，希望能將此技術多加推廣。

牙醫師也推薦量測自律神經

意外地在網路上看到趙醫師的部落格，他也使用心律大師，他在文中推薦牙醫師量測自律神經。

趙醫師的部落格：
牙醫師教你深呼吸

使用心律大師之博碩士論文 整理 (更新 7/7)

參考：
使用心律大師之博碩士論文 整理 (更新)
使用心律大師之博碩士論文 整理

沒想到中國的大學的博士論文也有使用心律大師來做實驗，更新列表如下圖，論文名稱紅字部分為此次更新部分。

使用心律大師之博碩士論文 整理 (更新)

參考：使用心律大師之博碩士論文 整理

使用心律大師之博碩士論文 整理如下表 (論文名稱紅色字體者為此次更新新增之論文)：

使用心律大師之博碩士論文 整理

已有不少大專院校使用心律大師進行HRV與自律神經相關之研究，到目前為止已產出不少博碩士論文，使用心律大師之博碩士論文 整理如下表：

心跳變異性與自律神經的關係. Relations of heart rate variability (HRV) and autonomic nervous system (ANS).

前面已經介紹過，自律神經系統分為「交感神經」及「副交感神經」，分布在內臟、血管、腺體等器官，它們共同控制呼吸、心跳、胃腸、生殖、分泌、排汗、體溫等功能。交感猶如踩油門，副交感猶如踩煞車，兩者互相制衡但又合作無間。自律神經運作功能和諧時，身體狀態便會穩定，若是自律神經運作功能不和諧時，相關器官都有可能會出現不適症狀，就是所謂的自律神經失調 ( Dysautonomia )。

那麼，心臟跟自律神經有什麼關係，為什麼從心跳變異性(HRV)可以看出自律神經的運作是否正常？

因為心率的調節是由自律神經來掌控，一般人大都以為心臟的跳動是一種恆定的狀態，其實不然，心跳並非完全以固定的速度跳動，每次心跳與心跳之間的間隔，可能會存在著幾毫秒的差異，這就是心跳變異性 (heart rate variability, HRV)。如果是安裝心跳節律器的病患，那麼每次心跳的間隔就恆定，就沒有心跳變異性。

在正常的心率下，心跳變異愈大，表示心臟功能愈強，原因是我們可以把心跳變異視為心臟對於周遭環境狀況的適應調節能力。例如緊張時，身體必須有較大量的血流，心臟就要跳得快一點來供應更多的血液；而休息時，身體需要安定放鬆，所以心臟應該要跳得慢一點。

由此可知，心臟調節能力越好，代表自律神經功能越正常，心臟調節能力差，代表自律神經失調，所以從HRV心律變異率，可以判斷自律神經運作的狀態。

人體是會自動調節的，所以 HRV 的數值與血壓一樣並非是固定的，一天之中這個數值是會有變化的，這就是自律神經在調節的表現。

什麼是自律神經失調 ( Dysautonomia )

為何自律神經會失調

正常狀態下,自律神經系統透過交感及副交感神經調節體內器官及分泌系統的需求. 所謂“自律神經失調”係泛指自律神經的調解功能異常,不足或喪失; 自律神經失調的根源可能是內臟器官異常或自律神經組織受損,再進一步分析,生活習慣不正常也是原因之一.

以下列出造成自律神經失調的常見原因:

-內臟器官發炎(受到細菌及病毒感染,如急性肝炎,腎炎,肺炎等)
-心血管疾病(如高血壓,血管硬化,中風,心肌梗栓等)
-荷爾蒙分泌異常
-糖尿病(末期時會造成神經末稍損壞)
-憂鬱症(中樞及週邊神經系統異常)
-營養不足(如缺乏電解質,維他命等)
-不規則生活習慣(晝夜顛倒)
-壓力過大(長期處於緊張,交感旺盛狀態)
-藥物中毒(汞,鉛,西藥,中藥等,造成神經組織破壞)
-藥物副作用(西藥,中藥,尤其是減肥藥,失眠藥等)

自律神經失調常見症狀

下列的症狀可能與自律神經失調有關(但需進一步由醫師診斷)
-經常耳鳴
-胸腔或心臟部位有壓迫感
-常有心悸的感覺
-常覺得呼吸困難
-比別人更容易氣喘
-夏天手腳冰冷
-常食慾不振
-消化不良
-吃東西之後或空腹時肚疼
-經常下痢
-經常便秘
-手腳,肩膀,或頸部痠痛
-臉部有潮紅現象
-常有頭痛
-常有目眩
-常有快要暈倒的感覺
-身體常大量出汗
-常覺得疲憊不堪
-經常失眠,無法入睡

甚麼是自律神經 Introduction of ANS

自律神經的簡單介紹如下：

• ANS的英文全名是Autonomic Nervous System,中文為自律神經系統。
  
• ANS又稱為自主神經,也就是不需主觀意識它自己就會運作了。
  
• ANS掌控人體90%以上的活動，能說它不重要嗎？
  
• ANS分為交感與副交感,交感猶如踩油門，副交感猶如踩煞車,兩者互相制衡但又合作無間.。ANS之詳細功能，請參見下面圖一及表一。
  
• 交感主緊張、戰鬥、憤怒、與潰逃，而副交感主休養、恢復、鬆弛、消化、與吸收。
  
• 如果說人體免疫系統的功能是對抗細菌、病毒及其他外物入侵，那麼ANS的生理功能就是應付外在環境的變化及壓力。
  
• 為什麼有的人抗壓性差，而有的人卻老神在在？ ANS功能強弱是其主因。
  
• 許多查不出原因的身體不適都是自律神經失調所致。
  
• 這麼重要的身心功能，健康檢查時有檢查嗎？答案是沒有，所以才要推廣自律神經的檢測。 

圖一

 表一 自律神經系統：交感神經與副交感神經系統之控制功能

結構	交感神經的刺激	副交感神經的刺激
虹膜（眼睛肌肉）	瞳孔放大	瞳孔縮小
唾液腺	唾液減少	唾液增加
口/鼻黏膜	黏液減少	黏液增加
心	心跳加快;心肌收縮力增強	心跳變慢心;肌收縮力降低
肺	支氣管肌肉放鬆	支氣管肌肉收縮
小腸	蠕動減少	消化作用增加
大腸	蠕動減少	分泌，增加蠕動
肝	肝醣轉換成葡萄糖	肝醣合成微幅增加
腎	減少尿液分泌	增加尿液分泌
腎上腺	正腎上腺素和腎上腺素的分泌
膀胱	囊壁鬆弛 肛門括約肌關閉	囊壁收縮 肛門括約肌鬆弛
汗腺	全身排汗增加
生殖器官功能	射精	充血/勃起
血管	緊縮	擴充
腦部活動	增加
新陳代謝率	增加

使用心律大師之論文 -- 芳香療法於國小教師自律神經的調整作用

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使用心律大師之論文 -- 探討運動前後對人體神經系統反應行為之研究

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使用心律大師之論文 -- 輪班護理人員工作壓力之研究

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使用心律大師之論文 -- 尿毒症患者心率變異與代謝症候群、糖尿病及高敏感度C反應蛋白血清濃度的探討

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使用心律大師之論文 -- 駕駛模擬環境下心率變異(HRV)等生理參數變化之探討

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東森新聞介紹心律大師

此影片為心律大師發明人孫博士接受東森新聞專訪影片，影片中之機型為第一代心律大師。

自律經檢測儀 -- 心律大師 ANSWatch 適用對象

輕巧、方便使用的自律神經檢測儀：心律大師 ANSWatch

自律神經檢測/心血管脈波分析/中醫脈診
世界首創 腕式生理監視器
台灣美國臨床驗證
全球專利

適用對象

中醫師、醫院、診所、健檢中心、學術研究、另類療法 (自然療法、芳香療法、園藝治療、音樂治療、瑜珈、靜坐、紓壓、氣功) 等。

醫院診所科別(可健保亦可自費檢測)：

身心科 (精神科)：身心自律神經失調為現代文明病，通常因為工作壓力過大與生活作息不正常所導致，與精神疾病如恐慌症、憂鬱症、躁鬱症、睡眠障礙、精神分裂症等疾病有極大的關聯性。
神經內科：巴金氏症、多發性系統退化症與脊髓損傷的病人，常伴隨自律神經的異常。
新陳代謝科：一些研究已經證實自律神經病變為糖尿病常見之神經併發症，美國糖尿病學會建議將自律神經檢查列為糖尿病患例行性神經檢查之一。
腎臟科：洗腎病患與尿毒症患者之神經損傷評估。
復健科：心肺功能復健狀況評估、脊髓性損傷病患復健狀況評估、早期療育過動兒自律神經狀況評估與檢測等。
心臟科：檢測心律不整、二尖瓣膜脫垂、動脈硬化等。
家醫科：自律神經狀況檢測。
小兒科：自律神經狀況檢測。
中醫科：脈診分析、藥性評估。
健檢中心：專業健康檢查與報告分析。

學術研究適用系所：

醫學相關系所、中醫系所、生理相關系所、心理相關系所、健康照護相關系所、藥學相關系所、醫工相關系所、醫學中心/教學醫院等有發表論文需求之教授與研究人員。
心律大師之資料可由電腦轉出 raw data與 Excel 表格，方便研究者進行其他數據分析方法，且心律大師已獲FDA認證，可作為標準研究設備，對研究人員撰寫論文有很大的幫助。

另類療法適用對象：

自然療法、芳香療法、園藝治療、音樂治療、瑜珈、靜坐、紓壓、氣功等。
可適用於治療前後之自律神經狀況比對。
即時心跳與HRV監測功能可於治療過程中即時監測心跳與HRV變化之情形。

ECG, Aortic pressure and Cardiac sound

下圖為生理學(physiology)課本常見的心電圖(ECG)、血液脈波與心音在心臟收縮(Systole)與舒張(Diastole)的相關圖：

論文研討：Validation of pulse rate variability as a surrogate for heart rate variability in chronically instrumented rabbits

Validation of pulse rate variability as a surrogate for heart rate variability in chronically instrumented rabbits

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HRV parameters, 心跳變異性參數

心跳變異性的時域參數如下：

心跳變異性的頻域參數如下：