• 作者： 何橈通；周澤義；陳如菱；鄧珮如；林文翰；葉振聲；蔡世澤
• 作者服務機構： 榮民總醫院?科部新陳代謝科; 國防醫學院?科學系
• 中文摘要： 近五年來，由於發現一套簡單且無傷口的心?血管反射系統的檢?方法，提供了一個臨床診斷自主神經系統功能異 常的簡單模式。本實驗之研究對象?正常人四十二人，糖尿病無自主神經症者十九人，及糖尿病有自主神經症者二十四人。方法?採用較敏感可靠之四項記?器，親察及記?其瞬時心律變異，及其在以下諸狀態之變化:靜態，深呼吸一次，深呼吸十二次，佛氏動作以維持胸腔正壓四十毫米汞柱三十秒，及改變立姿。另外又記?其血壓在立姿與 在等常肌肉收縮時之變化。結果顯示，各項記?在此三組對象，均有顯著差異。其中深呼吸十二次之試驗最?敏感，可做篩選試驗。佛氏動作異常者，計有四種型態，其意義尚待進一?研究。本實驗並對診斷國人糖尿病有向主神經症之標 準，提出了數據之建議。
• 英文摘要： A group of simple, non-invasive and reproducible cardiovascular reflex tests have been developed over the past decade to diagnose the diabetic autonomic neuropathy. We used Grass 4 channel polygraph to study 3 groups of subjects: 42 normal healthy volunteers, 19 diabetic patients without autonomic neuropathy, and 24 diabetic patients with autonomic neuropathy. The instant heart rate was recorded under the following conditions in each subject: (1) resting for one minute, (2) single deep breathing, (3) 12 deep breathings, (4) Valsalva Maneuver at 40 mm Hg for 30 seconds, and (5) standing. The change of diastolic blood pressure on 1/3 maximal handgrip (isometric contraction) was also recorded. The results showed that almost all of the measurements were significantly different among these 3 groups of subjects. Among the various tests, 12 deep breathings seemed to be the most sensitive and discriminative and suitable for a screening test. There were 4 types of abnormal responses to Valsalva Maneuver in patient groups. A set of cutoff value and a score system for the diagnosis of diabetic autonomic neuropathy were suggested.
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