臺灣博碩士論文加值系統

人體的安靜心跳率受到自律神經平衡性的影響，在極端的情形，例如，負G加速度（－Gz）可因抑制延腦的心臟加速中樞，促使心跳減慢；臉浸冷水則經由刺激臉部的三叉神經，增進迷走神經的活性而導致心搏徐緩。本研究主要目的是以4℃冷水反覆地刺激迷走神經，以觀察其對心跳率之加乘作用的影響。
　　本研究共計28位男性大學生志願參加，以三次反覆臉浸冷水（4℃），歷時20秒的方式來刺激迷走神經，時間的間隔為15分鐘。每次臉浸冷水時的即時心跳率變化以氧脈計記錄，並計算其降低量和降低率；臉浸冷水後15分鐘內的心跳變異率（HRV）則以頻譜記錄器擷取電波訊號，並以軟體分析代表迷走神經活性和交感神經的活性的高頻率波（HF）和低頻率波（LF %），各時段的浸水前後測量值重複量數分析考驗檢定其顯著的差異性。每位受試者亦以哈佛登階法間接地評量其體能狀況，並以相關係數分析考驗其與心跳的降低程度之相關性。
　　每次臉浸冷水後心搏徐緩的發生非常快速，心跳率平均於12.4秒內降至最低值。心跳變異率的分析顯示在45分鐘內的三次反覆刺激迷走神經，逐漸地使其活性升高，在最後的一次實驗，根據心跳頻率發現迷走神經活性顯著地凌駕交感神經的活性。此外，第一次臉浸冷水後心跳的降低量和降低率均與體能指數之相關係數分別為（r = 0.472,
P＜0.05;r = 0.556,P＜0.01），均呈顯著的正相關。
本研究與垂直轉輪及傾斜檯等具相同效果的方法反覆刺激迷走神經，其結果顯示對心搏徐緩的反應有加乘的效果。惟仍需更進一步研究予以驗證，以確立其相關趨勢。

The resting heart rate （HR） is the result of sympathovagal balance. It was reported that sinus bradycardia could be induced by negative acceleration （－Gz） or facial immersion in cold water. The underlying mechanism is evoking the efferent vagus nerve distributing on sino-atrial node. The goal of this study is to investigate if there is an addition effect when the vagus nerve is repeatedly stimulated.
28 healthy male undergraduates volunteered to participate as subjects and their physical fitness were evaluated prerviously. Cold water immersion （4 ℃, for 20 seconds） was conducted 3 times separated by 15 minutes. The beat-to-beat HR was monitored by oximeter for recording the lowest HR. The heart rate variability （HRV） was also captured using a miniature physiological signal recorder during post-water immersion. The low-frequency （LF %） and high-frequency （HF） powers were then analyzed.
The result showed that HR decreased very fast on each cold shock and reached the minimum within 12.4 seconds. Repeatedly, stimulating vagus nerve gradually increased its activity which even surpassed that of sympathetic nerve after the last water immersion. Besides, the decreasing rate of HR at the moment of first water immersion correlates with the physical efficiency index of subjects. The finding of this study indicates the potential risk of frequently stimulation on vagus nerve in aerobatics or diving.

目　錄
學位論文考試審議書....……………………………………….…………ⅱ
國家圖書館授權書∙……………………………………………………ⅲ
中文摘要……………………………………….…………………………ⅳ
英文摘要………………………………………………………….………ⅵ
誌謝………………………………………………………………….……ⅷ
目錄…………………………………………………………………….…ⅹ
表目錄……………………………………………….……..……….……xiii
圖目錄……………………………………………………………………xiv
附錄…………………………………………………….…………………xv
第壹章　緒論
　第一節　問題背景……………………………………………..………1
第二節 研究目的…………………………………………..…………3
第三節 研究假設…………………………………………..…………3
第四節 名詞的操作定義………………………………..……………4
第貳章　文獻探討
　第一節　心臟的神經分布…………………………………..…………5
第二節 迷走神經的刺激…………………………………..…………5
第三節 刺激迷走神經導致的生理問題…………………..…………6
第參章 研究方法.................................................................................8
第肆章 統計分析與結果
　第一節　臉浸冷水後心跳率的降低…………………….……………11
　第二節　心跳率的降低與體能指數的相關性……………...…..……11
　第三節　臉浸冷水後心跳變異率的變化………………...……..……11
　第四節　不同研究方法誘導心搏徐緩的結果比較…………….……12
第伍章　討論與結論
　第一節　研究方法的檢討…………………………………...…..……13
第二節 單次刺激迷走神經的反應……………………….....………14
第三節 反覆刺激迷走神經的反應………………...………..………15
第四節 體適能與心跳率降低的相關性………….……..…..………16
第五節 研究結果的應用與限制………………………….…………17
第六節 結論……………………………………………….…………18
參考文獻…………………………………………………….…..………19

表目錄
表1　臉浸冷水後心跳的降低量和降低率…………………….………22
表2　受試者登階測驗的體能指數………………………….…………23
表3　臉浸冷水後心跳降低量和降低率與體能指數的相關性…….…24
表4　臉浸冷水前各時段心跳變異率的變化…………………….……25
表5　以不同方法誘導心搏徐緩的結果比較………………….………26

圖目錄
圖1　HRV記錄器的裝設情形………………………….…..….………27
圖2　安靜心跳率的測量………………………………………….……28
圖3　臉浸冷水的實驗…………………………………….............……29
圖4　臉浸冷水的實驗流程…………………………….………....……30
圖5　各時段臉浸冷水後心跳降低率的變化………………….....……31
圖6　各時段臉浸冷水後高頻波的比較........…………….............……32
圖7　各時段臉浸冷水後能量頻譜中交感與迷走神經活性的消長….33

Andersen, H. T. (1963). The reflex nature of the physiological adjustments to diving and their afferent pathway (Vol. 58).
Andersen, H. T. (1966). Physiological adaptations in diving vertebrates. Physiological Reviews, 46(2), 212-243.
Banks, R. D., & Gray, G. (1994). Bunt bradycardia: two cases of slowing of heart rate inglight during negative Gz. Aviation, Space, and Environmental Medicine, 65(4), 330-331.
Banks, R. D., Grissett, J. D., Turnipseed, G. T., Saunders, P. L., & Rupert, A. H. (1994). The" push-pull effect". Aviation, Space, and Environmental Medicine, 65(8), 699-704.
Brooks, G. A., Fahey, T. D., White, T. P., & Baldwin, K. M. (2000). Exercise Physiology (3rd ed.). California: Mayfield Publishing Co.
Diedrichs, R. (1990). Adverse effect of negative Gz on subsequent high positive Gz- A need for research and education. Aeromedical and Training Digest, 4, 36-38.
Doe, C. P. A., Harnsworth, R., & Self, D. A. (1985). Baroceptor mediated vascular responses to simulated “push pull” in the anesthetized dog. Aviation, Space, and Environmental Medicine, 6(6), 481-485.
Ekblom, B., Kilbom, A., & Soltysiak, J. (1973). Physical training, bradycardia, and autonomic nervous system. Scandinavian Journal of Clinical & Laboratory Investigation, 32(3), 251-256.
Finley, J. P., Bonet, J. F., & Waxman, M. B. (1979). Autonomic pathways responsible for bradycardia on facial immersion. Journal of Applied Physiology, 47(6), 1218-1222.
Fox, S. I. (2005). Human Physiology (9th ed.). Boston: Graw-Hill Co. Inc.
Ganong, W. F. (1997). Review of Medical Physiology (18th ed.). London: Prentice-Hall International.
Gledhill, N., Cox, D., & Jamnik, R. (1994). Endurance athletes' stroke volume does not plateau: major advantage is diastolic function. Medicine & Science in Sports & Exercise, 26(9), 1116-1121.
Goldberger, J. J., Le, F. K., Lahiri, M., Kannankeril, P. J., Ng, J., & Kadish, A. H. (2006). Assessment of parasympathetic reactivation after exercise. American Journal of Physiology- Heart and Circulatory Physiology, 290(6), H2446-2452.
Gooden, B. A., Lehman, R. G., & Pym, J. (1970). Role of the face in the cardiovascular responses to total immersion. Australian Journal of Experimental Biology and Medical Science, 48(6), 687-690.
Goodman, L. S., & Lesage, S. (1998). Physiological responses to a tilt table simulation of the push-pull effect. Aviation, Space, and Environmental Medicine, 69(3), 202-205.
Hong, S. K., Song, S. H., Kim, P. K., & Suh, C. S. (1967). Seasonal observations on the cardiac rhythm during diving in the Korean ama. Journal of Applied Physiology, 23(1), 18-22.
Johnson, B. L., & Nelson, J. K. (1969). Practical Measurements for Evaluation in Physical Education. New York: Macmillam.
Kawakami, Y., Natelson, B. H., & DuBois, A. R. (1967). Cardiovascular effects of face immersion and factors affecting diving reflex in man. Journal of Applied Physiology, 23(6), 964-970.
Khurana, R. K., Watabiki, S., Hebel, J. R., Toro, R., & Nelson, E. (1980). Cold face test in the assessment of trigeminal-brainstem-vagal function in humans. Annals of Neurology, 7(2), 144-149.
Lemaitre, F., Buchheit, M., Joulia, F., Fontanari, P., & Tourny-Chollet, C. (2008). Static apnea effect on heart rate and its variability in elite breath-hold divers. Aviation, space, and Environmental Medicine, 79(2), 99-104.
Malliani, A., Pagani, M., Lombardi, F., & Cerutti, S. (1991). Cardiovascular neural regulation explored in the frequency domain. Circulation, 84(2), 482-492.
Maud, P. J., & Foster, C. (1995). Physiological assessment of human fitness. Illinois: Champaign.
McCarthy, G. W. (1996). Negative to positive G: The push-pull effect. Flying safety, September, 5-6.
Mohler, S. R. (1972). G effects on the pilot during aerobatics: Federal Aviation Administration Washington DC Office of Aviation Medicine.
Petrella, R. J., Cunningham, D. A., Nichol, P. M., & Thayer, R. (1999). Cardiovascular responses to facial cooling are age and fitness dependent. Medicine & Science in Sports & Exercise, 31(8), 1163-1168.
Pomeranz, B., Macaulay, R. J., Caudill, M. A., Kutz, I., Adam, D., Gordon, D., et al. (1985). Assessment of autonomic function in humans by heart rate spectral analysis. American Journal of Physiology- Heart and Circulatory Physiology, 248(1), H151-H153.
Ryan, E. A., Kerr, W. K., & Franks, W. R. (1950). Some physiological findings on normal men subjected to negative G. The Journal of Aviation Medicine, 21(3), 173-194.
Song, S. H., Lee, W. K., Chung, Y. A., & Hong, S. K. (1969). Mechanism of apneic bradycardia in man. Journal of Applied Physiology, 27(3), 323-327.
Tipton, M. (1989). The effect of clothing on “diving bradycardia” in man during submersion in cold water. European Journal of Applied Physiology and Occupational Physiology, 59(5), 360-364.
Tortora, G. J., & Evans, R. L. (1986). Principles of human physiology. New York: Harpercollins College Div.
Whayne, T. F., & Kellip, T. (1966). Diving bradycardia in man: comparison of different stimuli and clinical application. Circulation, 34(Suppl 3), 238.
White, S. W., & McRitchie, R. J. (1973). Nasopharyngeal reflexes: integrative analysis of evoked respiratory and cardiovascular effects. Australian Journal of Experimental Biology and Medical Science 51, 17-31.
Wilmore, J. H., Costill, D. L., & Gleim, G. W. (1995). Physiology of sport and exercise. Medicine & Science in Sports & Exercise, 27(5), 792.
Xing, Z. W., Lu, Z. C., Chen, G. X., Xia, L., Ding, Y. G., & Xu, C. (2000). Cerebral blood flow velocity by transcranial Doppler during a vertical-rotating table simulation of the push-pull effect. Aviation, space, and Environmental Medicine, 71(5), 485-488.
張五星、詹長祿、耿喜臣 （民88）。在加速度作用中的推拉效應。中華航空航天醫學雜誌，1，54-57。
溫德生 （民81）。負Gz航空生理的回顧與前瞻。中華民國航太學會學術研討會論文集，587-868。
溫德生、陳俊芳、張金木 （民81）。抗G動作對負G轉換為正G的防禦價值探討。航空醫學會刊，15-26。
蔡玉敏、溫德生 （民94）。臉浸冷水誘導的心搏徐緩：有氧能力評估的應用。航空醫學暨科學期刊，1，19-24。