運動後低血壓與血流動力學分析之文獻回顧

A brief review of physiology in post-exercise hypotension and application of arterial hemodynamic analysis

高血壓在流行病學中被視為罹患心血管疾病的一大重要影響因子，運動常作為非侵入性治療或預防高血壓的策略，為了探討運動如何在長期累積下對血壓調控達到顯著效果，研究單次運動後血壓變化是一個重要的議題。運動後低血壓（post-exercise hypotension, PEH）為單次運動後收縮壓及舒張壓下降至低於安靜值的現象，過去對於PEH的研究多數集中於有氧運動介入，近來則慢慢出現阻力運動與混合兩者的運動類型。以往觀察動脈特性較常使用脈波傳導速率（pulse wave velocity, PWV）及動脈順應性（compliance），而血流動力學理論是由不同的基礎架構去解釋血管與血流之間的交互作用，主要分為波形反射理論（wave reflection）及動脈水庫理論（arterial reservoir），其中涵蓋許多被使用於預測心血管疾病及罹患率的血流動力學指標，包含動脈增幅係數（augmentation index, AI）、反射波（Pb）、波動壓力（excessive pressure integral, XSPI）等。由於波形量測具有一定的方便性，使得血流動力學指標在運動方面具有相當之臨床應用性。本文將探討不同運動類型引起之PEH現象間的差異，並介紹血流動力學理論指標，以及針對運動與血流動力學目前發展的相關研究，進行文獻回顧。

Hypertension is a major risk for cardiovascular events in epidemiology and exercise is often used as a noninvasive treatment or a preventive strategy. To understand how exercise could benefit blood pressure regulation from long-term perspectives, investigating blood pressure changes after a single bout of exercise is critical. Post-exercise hypotension (PEH) is a phenomenon of which both systolic blood pressure (SBP) and diastolic blood pressure (DBP) drop below baseline after a single bout of exercise. Most PEH studies focused on aerobic exercise, and there have been more studies focused on resistance training and combined exercise in recent years. Pulse wave velocity (PWV) and arterial compliance are typical parameters on monitoring arteries health, yet hemodynamic theories provide more insights on the interaction between blood vessels and blood flow. Of them, wave reflection theory and arterial reservoir theory derive several hemodynamic indices that are predictive for cardiovascular disease, including arterial augmentation index (AI), backward pressure wave (Pb), excessive pressure integral (XSPI). Due to its high accessibility on obtaining arterial waveforms, the hemodynamic index might be also useful in exercise setting. This review will cover the most recent literature regarding PEH phenomena caused by different types of exercise, the hemodynamic theories and parameters, as well as the literature on exercise and arterial hemodynamics.