運動合併穴位電刺激對第2型糖尿病患之血液動力與心跳變異的影響

Abstract

運動合併穴位電刺激對第2型糖尿病患之血液動力與心跳變異的影響 94年6月 研究生 郭芳娟 指導教授 林正常

本研究的目的為：（一）探討運動與電刺激對糖尿病患之血液動力及心跳變異的影響；（二）探討運動與電刺激對糖尿病患之血漿中一氧化氮（nitric oxide; NO）、β-腦啡（β-endorphin）及腎上腺素（epinephrine）的影響；（三）探討血糖控制之水準與電刺激對糖尿病患運動中血液動力及心跳變異的影響；以及（四）探討血糖控制之水準與電刺激對糖尿病患NO及血糖的影響。方法：以68位第2型糖尿病患為受試者（50.25±7.18歲），依據glycosylated haemoglobin（HbA1C）≥8.0%或HbA1C＜8.0%分成血糖控制差（poor glycemia control, PDM）或血糖控制佳（good glycemia control, GDM）2組。每群受試者，隨機分配至運動合併電刺激（ES）或運動組（NES）。所有受試者以漸增負荷的腳踏車運動為處方，運動15分鐘。運動合併電刺激組，其2對刺激電極分別貼於左側上肢內關、曲澤穴，左側下肢血海與陰陵泉穴，以動作閾值的強度刺激。以脈搏描記圖測量小腿血管的傳導性。心臟自律神經的張力以心跳變異分析檢測。血漿中NO、β-endorphin及epinephrine的濃度以酵素免疫法檢測。結果：一、運動使GDM的靜脈流速、靜脈容量與靜脈張力在運動後下降，血漿中β-endorphin的濃度下降，而epinephrine濃度上升。GDM運動中的平均R-R間距降低，R-R間距的標準差升高。二、PDM運動中的高頻功率、最大運動負荷及運動後之下肢循環低於GDM。三、DM運動中合併電刺激組的動脈充血反應顯著增加（P＜.05）；有、無電刺激對所有靜脈參數並無顯著影響。四、糖尿病控制程度與電刺激二因子對血漿中NO及β-endorphin濃度未有顯著的影響，但電刺激組的epinephrine濃度上升。結論：血糖控制之水準會影響下肢在運動中循環的調控，PDM無法因應運動需求適當調整局部血管、心跳、血壓。運動合併電刺激能增加局部動脈充血，顯示對第2型DM的下肢循環可能有助益。 關鍵字：運動，電刺激，糖尿病，血液動力，心跳The Effects of Exercise and Electric Stimulation on Hemodynamic Function and Cardiac Autonomic Activity in Type 2 Diabetes Patients 2005/6 Student: Kuo Fang-Chuan Adviser: Lin Jung-Charg Objective: The aim of the present study was to determine the effects of exercise and exercise combined with electric stimulation (ES) on hemodynamic functions and blood cytokine in type 2 diabetes mellitus (DM) patients. Method: Sixty eight subjects having type 2 of diabetes (38 women, 30 men) with a mean age of 50.25±7.18 years were recruited. Diabetes patients were further subdivided based on their glycosylated haemoglobin（HbA1C）level to poor control DM with HbA1c ≥8.0% (PDM) or good control DM with HbA1c＜8.0% (GDM). All subjects were randomly assigned to exercise (NES) or exercise combined with ES treatment (ES), respectively. All subjects performed for 15 minutes in incremental bicycle exercise. The locations of ES that performed on the subject during exercise were on the left Neiguan (P6), Quze (PC3), Xuehai (SP10), and Yinlingquan (SP9) points simoultaneously. The current intensity of ES was set at the visible motor threshold. The hemodynamic function was measured by impedance plethysmography over bilateral calf muscles. Changes in heart rate were examined with a preamplifier and then digitized through software of HRV660.EXE installed in the laboratory PC. Plasma β-endorphin and nitric oxide (NO) were measured with ELISA. Results: (1) Exercise decreased venous tone, flow, and capacity of calf in GDM groups. Compared to the resting stage, exercise produced a higher SDNN and a lower R-R interval in HRV. Plasma -endorphin was decreased after exercise. (2) GDM had a higher hemodynamic function, HF of HRV than that of PDM during exercise, whereas PDM group had a higher heart rate and diastolic blood pressure during exercise stage. (3) Increase in hypermic arterial inflow was significantly higher in ES than in NES groups. (4) Plasma NO and β-endorphin levels between ES and NES were not significant. Conclusion: Hemodynamic function and cardiac autonomic activities were much lower in PDM group than that in GDM. Increase in hypermic arterial inflow was significantly higher in ES than in NES groups. These changes had independently occurred and not related to the change in plasma β-endorphin level and NO. These results suggested that exercise in combination with ES might have a benefit for the subject having type 2 diabetes in terms of therapeutic strategy. Key Words: Exercise, Electric stimulation, Diabetes mellius, Hemodynamics, Heart rate