溫泉浴對心血管功能的健康效益

Abstract

背景：在過往許多研究中，熱水浴已被驗證是一種可以改善人們心血管健康的有效方法。 臺灣則以其豐富多樣的溫泉旅遊資源而聞名，這些溫泉在醫療保健方面同樣具有巨大潛力。 本項研究旨在探討臺灣本土溫泉在預防心血管疾病方面的健康效益。 本次研究在溫泉浴前、中、後分別測量受試者的心血管功能，以驗證溫泉浴對心血管健康的有益影響，並具體分析影響的個人及環境因素的影響。 本研究瞭解40分鐘溫泉浴過程中及浴後40分鐘休息期間，血中含氧量、耳溫、心血管功能及心率可變異性之變化趨勢，此外，本研究還將關注溫泉洗浴的季節性影響，評估不同季節使用溫泉浴的健康效益，以及溫泉浴過程中可能存在的健康風險。 材料與方法：我們招募健康志願者參與此次溫泉浴與心血管健康效應之研究。測試地點位於新北市金山區舊金山總督溫泉，是屬於含有高量鐵質的溫泉，溫泉泉質是酸性硫酸鹽氯化物泉。測試分別於2019年3，4，6，8，10，11及12月進行了7次，分別招募受試者17、24、14、17、18、13、15名。受試者全程佩戴心率檢測裝置，用於人體心電圖活動訊號量測。研究過程中共有5次量測，包括心脈儀(血壓及心血管功能)、血氧、耳溫(中心體溫)測量，每個人單次預計量測在5分鐘內完成。受試者在完成第一次測量後進入溫泉場域，採用坐浴姿勢，溫泉溫度維持在攝氏38-40度，是一個有一半遮雨棚且通風良好的室外溫泉場域，溫泉水浸沒至胸口高度，20分鐘後進行第二次測量，再返回溫泉中繼續浸泡20分鐘後面進行第三次測量，結束浸泡後，於溫泉場域的室外休息區穿著寬鬆衣服休息20分鐘進行第四次測量，繼續休息20分鐘完成最後一次測量。 結果與討論：結果發現，溫泉浴可以降低血壓，延長左心室收縮時間，並且在溫泉浴後，左心室收縮力，左心室dP / dt Max以及心輸出量和指數也明顯降低。 四個季節研究之結果具有一致性，表明溫泉沐浴確實可以改善心血管健康。相比之下，夏季研究結果顯示在溫泉浸泡過程中心血管功能參數波動很大，主要是心跳加速，且左心室收縮輸出量增加非常明顯，這可能是潛在的健康風險。 原因可能是夏季的室外高溫環境，導致溫泉浴過程中，受試者的心血管系統負擔增加。至於冬季的風險是，環境溫度較低，受試者在溫泉浴過程中，血壓下降非常明顯，也是一個冬天溫泉浴的潛在風險。 結論：溫泉沐浴可以改善心血管功能。可能的機制可能是通過降低血壓、減少心臟工作量來介導的。 不建議夏季在室外高溫下溫泉浴。温泉改善心血管功能的影响取决於年齡，性別，體重，是否有憂鬱症，是否使用高血壓藥物等因素。

Background: Bathing in hot water has been demonstrated to be an effective way to improve people’s cardiovascular health in many studies. Taiwan is well known for its abundant tourism resources of varied hot springs, which may also have large potential in medical and health care implication. This study aims to examine the beneficial effects of hot springs in Taiwan for cardiovascular disease prevention. In this study, cardiovascular functions of our study subjects was measured before, during and after hot spring bathing to show its beneficial health outcomes on cardiovascular health. Furthermore, the effect of several confounding factors such as environment temperature and personal body temperature, anti-hypertensive medication, habitual hot spring bathing, were considered in our statistical analysis. This current study also focused on seasonal effects of hot spring bathing and the potential health risks come along with, to give suggestion on suitable season for hot spring bathing. Materials and methods: We recruited healthy volunteers to participate in the cardiovascular promotion program of hot spring bathing and cardiovascular effects. Our study takes place at Old Jinshan Governor-General Hot Spring located in New Taipei City. The hot spring water quality were analyzed three times in different seasons, and was categorized as acid-sulfate-chloride hot spring and rich in iron. Hot spring temperature was adjusted and maintained about 38-40 degree of Celsius during study. The tests were performed once per month in 2019 since March for a total of seven tests. The number of participating subjects were 17, 24, 14, 17, 18, 13, 15, respectively. The electrocardiogram and heart rate variability data of each subject was collected throughout the whole study process. Cardiovascular function by using DynaPulse were conducted five times for each participant during the study process, including baseline, 20 min and 40 min during hot spring bathing, and resting 20 min and 40 min after bathing, respectively. In addition, blood oxygen saturation level (SpO2) and ear temperature measurements were also recorded simultaneously. The protocol began with a first measurement before bathing, then the subjects were immersed in hot spring in a sitting posture to the chest for 20 minutes and take the second measurement. The subjects then repeated the immersion again for 20 minutes and received the third measurement. After that, the subjects rest for 20 minutes and take the forth measurement, then rest another 20 minutes and take the final fifth measurement. Results and discussion: Hot spring bathing can lower blood pressure, and there was also significant decreases in heart rate, left ventricular contractility, left ventricular dP/dt Max, and cardiac output and index after hot spring bathing. Consistent results were observed in 4 different seasons, that hot spring bathing can improve cardiovascular health in all seasons. In contrast, the summer (June and August) tests show participants experienced a higher heart rate accompanied with significant increase in cardiac output during hot spring bathing process (at 20 and 40 min) compared with other seasons, which indicated the potential cardiovascular risk for hot spring bathing in summer season. Another potential risk was noted that a significant blood pressure lowering during hot spring bathing process in winter season in comparison with other 3 seasons. Conclusions: Hot spring bathing is shown to improve cardiovascular function. The plausible mechanism might be mediated via reducing cardiac workload. However, hot spring bathing under high outdoor temperature in summer is not suggested. The effectiveness of hot spring bathing depends on factors such as age, gender, body mass index, whether is depression, whether on high blood pressure drugs.