| 摘要: | 本研究以中醫學運用陰陽對立及調和的觀點來探討自律神經功能活動，利用超音波改善傳統針刺針灸弱點，以改變不同參數刺激穴位，經由心率變異度分析、觀察超音波刺激左腳申脈與照海穴5分鐘後的時域、頻域與基本生理指數改變情形，以解釋經由照海或申脈穴位超音波刺激後，調整自律神經功能平衡的相關性，並藉此探索超音波的最佳參數。 本試驗共有110位自願受試者參加，以隨機分組方式分配到照海組55位，平均年齡37.1±11.4歲，申脈組55位，平均年齡39.2±10.5歲，兩大組內依抽籤有六種不同的參數分組進行試驗，包括旋轉按摩組、假性超音波輸出組、1MHz連續波式超音波組、3MHz連續波式超音波組、1MHz脈衝波式超音波組、3MHz脈衝波式超音波組、每位受試者相隔一天以上可分別參加照海或申脈穴1至6次不同參數組試驗。 以成對樣本t檢定或無母數分析比較組內前後的差異、並以共變數分析與標準化百分比改變量比較組間差異，結果顯示使用不同的參數刺激之後，對於基本生理指數如收縮壓、舒張壓、平均心跳並無明顯改變。在心率變異度時域、頻域分析方面，照海與申脈穴在SDNN、TP、HF在六個參數分組標準化百分比改變量均呈現增加趨勢，但在參數組間無明顯差異。LF部份則是照海組在六個參數分組低頻功率標準化百分比改變量均呈現增加且有顯著組間差異(p＝0.013)，申脈組LF則是下降，但無顯著組間差異。照海組間百分比改變量在常規化低頻功率(normalized LF, nLF)（交感神經系統活性定量指標）(p＝0.023)與低高頻功率比LF/HF（自律神經系統活性平衡指標）(p＝0.009)，呈現顯著組間差異。 整體而言，照海組較申脈組在頻譜功率標準化百分比改變量有效，不同的參數中，旋轉按摩組出現安慰劑效應的可能性，3MHz較1MHz效果明顯，連續波產生的效果類似針灸中「補」的手法，脈衝波產生的效果類似針灸中「瀉」的手法。顯示照海與申脈穴經超音波刺激後，可影響自律神經系統的平衡性，本研究可作為未來進一步探討超音波刺激穴位如何調整自律神經活動的基礎。
A randomized controlled clinical trial was conducted to assess the change of autonomic nervous system (ANS) by ultrasonic stimulations of the acupoints. Specifically, ultrasound frequencies of 1 and 3 MHz associated with different duty cycles of the tone burst wave at different acoustic power were employed to stimulate the Shenmai (BL 62) and Zhaohai (KI 6) acupoints on subjects’ left foot according to the yin-yang theory in the Chinese medicine meridian system. Blood pressure (BP) and parameters of heart rate variability (HRV) were measured to evaluate the change before and after the stimulation. A total of 110 healthy volunteers were randomly allocated to two acupoint groups, each with six subgroups of different treatments which include circular massage (no ultrasound wave), sham (no ultrasound wave), 1MHz continuous wave ultrasound, 3MHz continuous wave ultrasound, 1MHz pulsed wave ultrasound, and 3MHz pulsed wave ultrasound. Results from paired t-test or Wilcoxon signed-rank test, ANCOVA and standardized percentage change showed that the physiological effect such as systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean heart rate (MHR) were not significantly different between subgroups in the Zhaohai and the Shenmai group. In time-domain and frequency-domain analyses, the Standard Deviation of Normal to Normal Interval (SDNN), Total Power (TP) and high frequency power (HF) were not significantly different between subgroups in the Zhaohai and the Shenmai group. When analyzing with standardized percentage change, significant differences were found in Lower Frequency Power (LF) (p＝0.013), normalized lower frequency (nLF) (p＝0.023), and LF/HF (p＝0.009) between subgroups within the Zhaohai group. Overall, the 3MHz wave ultrasound groups were more effective than the 1 MHz groups. Contrast to the acupuncture reinforcing effect of continuous wave ultrasound, the pulsed wave ultrasound showed the possibility of reducing effect. The circular massage group (without ultrasound wave) seemed to exhibit placebo effect in heart rate variability. In conclusion, this study demostrated that ultrasonic stimulation on Zhaohai and Shenmai acupoints could lead to a beneficial effect on the autonomic nervous system. The findings can provide leads for further investigations of using ultrasonic acupuncture. |
