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    正念冥想是“冥想的一種類型，專注于體會(huì)當(dāng)前的感受，對(duì)這些感受不作任何類型的認(rèn)知加工，不作判斷，不試圖改變這些感受”.    由于在正念冥想過程中觀察到了呼吸頻率下降，因此一個(gè)患者亞組完成了第3次訪視，他們?cè)谠L視中采用控制性呼吸以作為第2種對(duì)照措施。在這次訪視中，他們把呼吸頻率降低至與正念冥想時(shí)相同的頻率。

    亞特蘭大——在美國(guó)腎病學(xué)會(huì)主辦的“2013腎臟周”上，來自埃默里大學(xué)的Jeanie Park博士報(bào)告稱，一項(xiàng)小規(guī)模隨機(jī)試驗(yàn)表明正念冥想可能有助于改善慢性腎病（CKD）合并高血壓患者的血壓控制情況。

    這項(xiàng)試驗(yàn)納入了15例3期慢性腎病合并高血壓的患者。受試者均為男性退伍軍人，以隨機(jī)交叉的形式完成了2次試驗(yàn)訪視，一次在指導(dǎo)下進(jìn)行14分鐘的正念冥想，另一次則接受14分鐘的血壓教育作為對(duì)照。

    結(jié)果顯示，與涉及血壓教育的對(duì)照措施相比，正念冥想與更大幅度的收縮壓下降（–10.2 vs. –0.8 mmHg）、舒張壓下降（–6.4 vs. –1.8 mmHg）和平均動(dòng)脈血壓下降（–7.7 vs. –1.4 mmHg）相關(guān)，差異有統(tǒng)計(jì)學(xué)意義。此外，微神經(jīng)圖顯示，正念冥想還與更大幅度的肌肉交感神經(jīng)活性下降（–10.7 vs. 1.9次脈沖/分）相關(guān)，差異也有統(tǒng)計(jì)學(xué)意義。

    Park博士說：“我們觀察到在正念冥想過程中，交感神經(jīng)活性較之對(duì)照組顯著下降，但在控制性呼吸過程中……交感神經(jīng)活性并無明顯差異。這說明緩慢呼吸本身不足以降低血壓和交感神經(jīng)活性，正念冥想可能起到了某種特別的調(diào)節(jié)交感神經(jīng)活性和血壓的作用。”

    雖然過去也有研究表明正念冥想在高血壓患者中可以起到“適度但有意義”的效應(yīng)，但我們這項(xiàng)研究的結(jié)果第一次在慢性腎病合并高血壓患者中證明了正念冥想與血壓下降之間的相關(guān)性。這種效應(yīng)可能是由交感神經(jīng)系統(tǒng)活性急性下降介導(dǎo)的。

    Park博士解釋道，慢性腎病以慢**感神經(jīng)系統(tǒng)活性過高為特征，這會(huì)在一定程度上導(dǎo)致高血壓和死亡。她說：“在臨床實(shí)踐中，我們希望阻斷交感神經(jīng)活性以降 低血壓。我們采用β受體阻滯劑、[**]等抗高血壓藥物來達(dá)到這一目的，但問題是這些藥物往往因其副作用而使用受限……所以，顯然我們有必要為患者尋 找其他替代或附加療法以對(duì)抗交感神經(jīng)活性并降低血壓。”

    Park博士總結(jié)道，這項(xiàng)研究的結(jié)果表明正念冥想可能對(duì)自主神經(jīng)控制的確有生理效應(yīng)，它可能有望成為慢性腎病患者的一種補(bǔ)充療法。她也指出，未來研究需要明確正念冥想是否能發(fā)揮長(zhǎng)時(shí)間的降壓效應(yīng)。

    正念冥想可調(diào)節(jié)個(gè)體的負(fù)性情緒、促進(jìn)個(gè)體正性情緒，對(duì)于心身疾病具有顯著的干預(yù)效用。正念冥想的再感知模型、正念應(yīng)對(duì)模型、推動(dòng)性上升螺旋模型以及正念情 緒調(diào)節(jié)模型都強(qiáng)調(diào)了正念冥想對(duì)情緒的調(diào)節(jié)作用。認(rèn)知神經(jīng)科學(xué)的研究發(fā)現(xiàn)，正念冥想可促進(jìn)左側(cè)前額葉腦區(qū)激活增強(qiáng)，涉及的腦區(qū)主要包括背外側(cè)前額葉皮層 （DLPFC）和背內(nèi)側(cè)前額葉皮層（DMPFC）。研究者進(jìn)一步發(fā)現(xiàn)，正念特質(zhì)是通過改善前額葉對(duì)邊緣系統(tǒng)反應(yīng)的調(diào)節(jié)來實(shí)現(xiàn)對(duì)情緒的調(diào)節(jié)作用。而且，這種調(diào)節(jié)作用還有可能體現(xiàn)為通過冥想訓(xùn)練分離聯(lián)結(jié)在一起 的兩種自我參照神經(jīng)機(jī)制，從而加強(qiáng)體驗(yàn)性神經(jīng)機(jī)制。另外，研究者還發(fā)現(xiàn)，正念冥想訓(xùn)練還可以改變與情緒加工相關(guān)的大腦結(jié)構(gòu)。進(jìn)一步澄清冥想訓(xùn)練與大腦偏側(cè) 化的關(guān)系和不同類型被試之間的比較研究將成為該領(lǐng)域日后研究的重點(diǎn)。

    By: SHARON WORCESTER, Cardiology News Digital Network

    ATLANTA – Mindfulness meditation may improve blood pressure in hypertensive patients with chronic kidney disease, according to findings from a small randomized study.

    This study involved 15 patients who had stage 3 chronic kidney disease and hypertension. Compared with a control condition involving blood pressure education, mindfulness meditation was associated with significantly greater reductions in systolic blood pressure （–10.2 vs. –0.8 mm Hg）， diastolic blood pressure （–6.4 vs. –1.8 mm Hg）， and mean arterial pressure （–7.7 vs. –1.4 mm Hg）， Dr. Jeanie Park reported at Kidney Week 2013, sponsored by the American Society of Nephrology.

    Mindfulness meditation – a “type of meditation that is focused on awareness of sensations of the present moment without any type of cognitive elaboration of those sensations, without judgment, without trying to modify those sensations” – also was associated with a significantly greater reduction in muscle sympathetic nerve activity as measured using microneurography （–10.7 vs. 1.9 bursts/min）， said Dr. Park of Emory University, Atlanta.

    Study participants were male veterans who completed two study visits, undergoing – in randomized crossover fashion – 14 minutes of guided mindfulness meditation at one visit, and 14 minutes of a control condition involving blood pressure education at one visit.

    Because a lower breathing rate was observed during mindfulness meditation, a subset of the patients completed a third visit in which they used controlled breathing as a second control measure. During this visit, they lowered their breathing rate to the same rate achieved during mindfulness meditation.

    “What we saw was that during mindfulness meditation, there was a significant reduction in sympathetic nerve activity compared with the control, but during controlled breathing … there was no difference in sympathetic activity. This suggests that slow breathing by itself is not sufficient to lower blood pressure and sympathetic activity, and that there is something unique about mindfulness meditation that might be modulating sympathetic activity and blood pressure in our patients,” Dr. Park said.

    Although mindfulness meditation has been shown in prior studies to have “modest but meaningful” effects in patients with high blood pressure, the current findings are among the first to demonstrate an association between mindfulness meditation and decreased blood pressure in hypertensive patients with chronic kidney disease. The effect appeared to be mediated by an acute reduction in sympathetic nervous system activity, Dr. Park said.

    Chronic kidney disease is characterized by chronic sympathetic nervous system overactivity, which contributes to hypertension and mortality, she explained.

    “In clinical practice, we aim to counteract sympathetic activity to lower blood pressure. We do this using antihypertensive medications such as beta-blockers and [clonazepam], but the problem with these medications is that oftentimes their use is limited due to their side effects … so there certainly is a need to investigate alternative or additive therapies to counteract sympathetic activity and lower blood pressure in our patient group,” she said.

    The findings of this study suggest that mindfulness meditation may have real physiological effects on autonomic control, and may prove useful as a complementary therapy in chronic kidney disease patients, she concluded, noting that future studies are needed to determine whether long-term reductions in blood pressure can be achieved by using mindfulness meditation.

    Dr. Park reported having no disclosures.