上下颈椎整脊疗法对志愿者及颈痛患者血压和心率变异性的影响：一项随机对照、交叉、初步研究。
Effects of Upper and Lower Cervical Spinal Manipulative Therapy on Blood Pressure and Heart Rate Variability in Volunteers and Patients With Neck Pain: A Randomized Controlled, Cross-Over, Preliminary Study.
作者信息
Win Ni Ni, Jorgensen Anna Maria S, Chen Yu Sui, Haneline Michael T
机构信息
Senior Lecturer, International Medical University, Chiropractic, School of Health Sciences, Kuala Lumpur, Malaysia.
Associate Professor, International Medical University, Human Biology, School of Medicine, Kuala Lumpur, Malaysia.
出版信息
J Chiropr Med. 2015 Mar;14(1):1-9. doi: 10.1016/j.jcm.2014.12.005. Epub 2015 Feb 7.
OBJECTIVE
The aims of this study were to examine autonomic nervous system responses by using heart rate variability analysis (HRV), hemodynamic parameters and numeric pain scale (NPS) when either upper (C1 and C2) or lower (C6 and C7) cervical segments were manipulated in volunteers, and whether such response would be altered in acute mechanical neck pain patients after spinal manipulative therapy (SMT).
METHODS
A randomized controlled, cross-over, preliminary study was conducted on 10 asymptomatic normotensive volunteers and 10 normotensive patients complaining of acute neck pain. HRV, blood pressure (BP) and heart rate (HR), and NPS were recorded after upper cervical and lower cervical segments SMT in volunteer and patient groups.
RESULTS
The standard deviation of average normal to normal R-R intervals (SDNN) increased (83.54 ± 22 vs. 105.41 ± 20; P = .02) after upper cervical SMT. The normalized unit of high frequency (nuHF), which shows parasympathetic activity, was predominant (40.18 ± 9 vs. 46.08 ± 14) after upper cervical SMT (P = .03) with a significant decrease (109 ± 10 vs. 98 ± 5) in systolic BP (P = .002). Low frequency to high frequency (LF/HF) ratio, which shows predominance of sympathetic activity increased (1.05 ± 0.7 vs. 1.51 ± 0.5; P = .02) after lower cervical SMT in the healthy volunteers group. However, there was an increase in SDNN (70.48 ± 18 vs. 90.23 ± 20; P = .02 and 75.19 ± 16 vs 97.52 ± 22; P = .01), a decrease in LF/HF ratio (1.33 ± 0.3 vs. 0.81 ± 0.2; P = .001 and 1.22 ± 0.4 vs. 0.86 ± 0.3; P = .02), which was associated with decreased systolic BP (105 ± 10 vs. 95 ± 9; P = .01 and 102 ± 9 vs. 91 ± 10; P = .02) and NPS scores (3 ± 1 vs. 0; P = .01 and 3 ± 1 vs. 1 ± 1; P = .03) following both upper and lower cervical SMT in the patient's group. The baseline HR was 67 ± 9 vs 64 ± 5 (upper cervical) and 65 ± 7 vs 69 ± 11 (lower cervical) in both the healthy volunteer' and patient' groups.
CONCLUSION
Upper cervical SMT enhances dominance of parasympathetic and lower cervical SMT enhances dominance of sympathetic activity in this young volunteer group. However, dominance of parasympathetic activity was found in patients with neck pain that received both upper and lower cervical SMT.
目的
本研究旨在通过心率变异性分析（HRV）、血流动力学参数和数字疼痛量表（NPS），检测在志愿者中对颈椎上段（C1和C2）或下段（C6和C7）进行手法治疗时自主神经系统的反应，以及在脊柱手法治疗（SMT）后急性机械性颈部疼痛患者的这种反应是否会改变。
方法
对10名无症状的血压正常志愿者和10名主诉急性颈部疼痛的血压正常患者进行了一项随机对照、交叉、初步研究。在志愿者组和患者组中，对颈椎上段和下段进行SMT后，记录HRV、血压（BP）、心率（HR）和NPS。
结果
颈椎上段SMT后，正常到正常R-R间期的平均标准差（SDNN）增加（83.54±22对105.41±20；P = 0.02）。显示副交感神经活动的高频标准化单位（nuHF）在颈椎上段SMT后占主导（40.18±9对46.08±14）（P = 0.03），收缩压显著降低（109±10对98±5）（P = 0.002）。在健康志愿者组中，显示交感神经活动占主导的低频与高频（LF/HF）比值在颈椎下段SMT后增加（1.05±0.7对1.51±0.5；P = 0.02）。然而，在患者组中，颈椎上段和下段SMT后，SDNN均增加（70.48±18对90.23±20；P = 0.02和75.19±16对97.52±22；P = 0.01），LF/HF比值降低（1.33±0.3对0.81±0.2；P = 0.001和1.22±0.4对0.86±0.3；P = 0.02），这与收缩压降低（105±10对95±9；P = 0.01和102±9对91±10；P = 0.02）和NPS评分降低（3±1对0；P = 0.01和3±1对1±1；P = 0.03）相关。健康志愿者组和患者组的基线心率分别为67±9对64±5（颈椎上段）和65±7对69±11（颈椎下段）。
结论
在这个年轻志愿者组中，颈椎上段SMT增强了副交感神经的主导作用，颈椎下段SMT增强了交感神经活动的主导作用。然而，在接受颈椎上段和下段SMT的颈部疼痛患者中发现了副交感神经活动的主导作用。
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