臺灣博碩士論文加值系統

中醫的脈診是累積數千年的臨床經驗，醫者經由手指施予不同程度的壓力，並由自身的觸覺來感受血管的反應，依據脈象的變化，來判斷病理上的狀況，所形成之中醫學獨特的診斷方法之一。
因此，本研究已完成自製壓脈袋(Cuff)、感測器固定支架及脈波量測系統之設計，利用小型壓脈帶結構的便利性及以不同施壓模式下擷取連續的脈搏訊號，進而收集施壓後血管（橈骨動脈）反應。藉此比擬中醫師在把脈時所使用浮舉、中尋及沉取之抽象壓力，並配合不同固定機構的設計可應用於各種部位上的壓力量測。
在實測方面，量測系統經脈搏模擬器試驗的結果發現在收縮壓誤差約在4.57mmHg±1.24，而舒張壓誤差約在4.16mmHg±1.69，之後以水銀式血壓計為標準，分別對系統及市售電子血壓計進行人體試驗，發現系統收縮壓及舒張壓平均誤差約4.85±3.98mmHg，與市售電子血壓計的誤差相比都來的小，因此，量測系統的血壓量測誤差及穩定度的方面，是符合一般電子血壓計的標準。
在脈波分析部分，本研究提出共振波輪廓及脈波特徵點之分析方法，並在臨床的試驗上，針對中醫師把脈後與系統量測之結果，對於常見之滑、澀、弦、弱等脈象進行初步驗證與對照，具備定量分析脈診之研究目的，以提供中醫脈診輔助診斷工具及心血管生理監測之應用。
最後將本研究設計之成果，用來量化中醫師於臨床診脈時之指下資訊並根據分析脈波訊號之技巧，未來可作為中醫科學化之輔助工具。

Pulse Diagnosis in the Chinese medicine has been developed and applied clinically for thousands of years. Doctors apply varying pressures with their fingers and sense responses of blood vessels through their touches. They give pathological diagnoses by the pulse signals. Pulse-taking is thus one of the unique diagnostic methods exclusive to the Chinese medicine.
Accordingly, this research project has developed the system design of a custom inflatable cuff, the supporting fixtures of sensors and the pulse measurement system.
This system acquires continuous pulse signals under different pressures with the help of small and portable inflatable cuffs and further collects responses of the blood vessel (the radial artery) under pressure. By this design, the system can emulate the pressures involved in techniques of light touching(浮舉), moderate feeling(中尋) and heavy pressing(沉取) that a Chinese medical doctor uses upon taking pulses. Moreover, combined with various designs of supporting fixtures, this system can measure pressures on a variety of positions.
Experimentally, this measurement system can achieve error margins of 4.57mmHg ±1.24 for systolic pressures and 4.16mmHg ±1.69 for diastolic pressures in tests on a pulse simulator. In subsequent tests on human bodies, the system gives average error margins of approximately 4.85 ±3.98mmHg for both systolic and diastolic pressures, which are smaller than what commercial electronic sphygmomanometers give.
Accordingly, the measurement errors and reliability of this measurement system are comparable to those of common electronic sphygmomanometers. In this research, the techniques of oscillation contour analysis and eigen-point analysis of pulse waves are proposed for pulse wave analysis. In clinical tests, the results produced by the measurement system are audited and compared with doctors diagnoses. In this way, the common pulse signals, such as “Hua (滑)”, “Se(澀)”,“Xian(弦)”, and “Ruo(弱)”, can be examined and diagnosis of pulse taking can be analyzed quantitatively. This system can be used for applications of diagnostic aids to pulse taking of the Chinese medicine and monitoring the cardiovascular physiological signals.
Finally, the system developed in this research can quantify the information a Chinese medical doctor uses upon clinical pulse taking and can serve, with the help of innovative techniques of pulse signal analysis, as an aid to scientific study of the Chinese medicine.

目錄
中文摘要.......................................................Ⅰ
英文摘要.......................................................Ⅱ
誌謝...........................................................Ⅲ
目錄...........................................................Ⅳ
圖目錄.........................................................Ⅵ
表目錄.........................................................Ⅸ
第一章 緒論...................................................(1)
1.1引言...............................................(1)
1.2中醫脈診簡介.......................................(1)
1.3研究背景與相關文獻.................................(1)
1.4研究動機與目的.....................................(3)
1.5論文架構說明.......................................(3)
第二章 研究方法..............................................(4)
2.1血壓量測之共振法...................................(4)
2.2加壓式血壓之脈波分析方法...........................(6)
2.2.1心率計算 ....................................(8)
2.2.2收縮壓、舒張壓、平均壓計算...................(9)
2.3恆壓式脈波圖之特徵點時域分析法 ...................(10)
第三章 系統硬體架構與設計....................................(12)
3.1數位電路部分......................................(13)
3.1.1 H8控制器....................................(13)
3.1.2 MAX1457 訊號調理控制器.......................(14)
3.2類比電路部分......................................(16)
3.2.1壓力感測器元件...............................(17)
3.2.2交流訊號放大電路.............................(18)
3.2.3 Sallen-Key 8階低通濾波電路...................(20)
3.3感測固定部分......................................(22)
3.3.1傳統式壓脈帶部分.............................(22)
3.3.2自製壓脈帶設計部分...........................(23)
3.3.3自行設計之固定架部分.........................(24)
第四章 軟體系統設計..........................................(27)
4.1即時脈波顯示介面..................................(27)
4.2脈波訊號剪輯及特徵點定位設計......................(29)
第五章 結果與討論............................................(32)
5.1 系統外觀..........................................(32)
5.2系統壓力感測器線性度驗證..........................(33)
5.3系統量測之結果....................................(36)
5.4脈搏共振輪廓之訊號分析............................(39)
5.5分段加壓模式之脈波訊號分析結果....................(45)
5.6中醫脈診臨床驗證..................................(48)
5.6.1中醫寸口脈基本脈型...........................(48)
5.6.2實驗結果.....................................(49)
5.7討論..............................................(51)
第六章 結論與未來展望........................................(55)
6.1結論..............................................(55)
6.2未來展望..........................................(56)
參考文獻.......................................................(58)

圖目錄
圖2-1手臂式壓脈帶壓迫血管示意圖..........................(5)
圖2-2手臂式壓脈帶未壓迫血管示意圖........................(5)
圖2-3壓力訊號與共振訊號之關係............................(5)
圖2-4加壓式壓力訊號與共振訊號之關係......................(6)
圖2-5訊號處理程序........................................(7)
圖2-6脈搏訊號與空氣幫浦加壓時所造成之訊號疊和............(8)
圖2-7心跳週期之示意圖....................................(8)
圖2-8血壓計算示意圖......................................(9)
圖2-9脈搏波特徵參數定義..................................(10)
圖3-1系統架構............................................(12)
圖3-2數位電路部分之硬體架構..............................(13)
圖3-3訊號調理控制器之內部結構............................(15)
圖3-4訊號調理控制器之輸出................................(15)
圖3-5多的調理器模組進行自動化調校........................(16)
圖3-6類比訊號部份之硬體架構..............................(17)
圖3-7壓力感測器(Fujikura FGN607)..........................(17)
圖3-8壓力感測器內部電橋結構..............................(18)
圖3-9交流訊號放大電路....................................(18)
圖3-10串接2級AC放大器之正弦波輸入實測結果...............(19)
圖3-11串接2級AC放大器之方波輸入實測結果.................(20)
圖3-12二階Sallen-key低通濾波電路.........................(20)
圖3-13實測8階Sallen-key LPF之頻率響應結果................(22)
圖3-14市售之血壓計所使用之壓脈帶.........................(23)
圖3-15小型壓脈帶之實際尺寸(上視圖).......................(23)
圖3-16小型壓脈帶之充氣膨脹後的大小(側視圖)...............(24)
圖3-17實際固定支架.......................................(25)
圖4-1脈波即時顯示畫面....................................(28)
圖4-2顯示介面程式架構之組織圖............................(29)
圖4-3脈波訊號剪輯介面....................................(29)
圖4-4以操作視窗(Viewing Window)的方式，進行脈波資料擷取....(31)
圖4-5以任意範圍進行脈波資料擷取..........................(32)
圖4-6剪輯程式架構之組織圖................................(32)
圖5-1脈波量測系統電路PCB之正面圖.........................(33)
圖5-2脈波量測系統電路PCB之背面圖.........................(33)
圖5-3自製壓脈帶實際量測之情況............................(34)
圖5-4傳統壓脈帶實際量測之情況............................(34)
圖5-5脈壓壓力值之線性度校正量測.. ........................(35)
圖5-6壓力感測器之轉換特性對應關係........................(36)
圖5-7系統實測結果分布圖..................................(39)
圖5-8電子血壓計實測結果分布圖............................(39)
圖5-9系統恆壓施壓之控制模式..............................(41)
圖5-10模擬訊號之原始資料.................................(41)
圖5-11下按時脈搏訊號之共振輪廓線.........................(41)
圖5-12脈壓差訊號.........................................(42)
圖5-13脈搏差輪廓線之參數定義.............................(42)
圖5-14實際測試之範例一...............................(43)
圖5-15實際測試之範例二...............................(44)
圖5-16實際測試之範例三...............................(45)
圖5-17原始訊號...........................................(46)
圖5-18以突波為閥值所分割的訊號處理.......................(47)
圖5-19不同施壓程度之16段連續脈搏訊號.....................(47)
圖5-20疊合後之脈搏訊號以二維座標表示.....................(47)
圖5-21疊合後之脈搏訊號以三維座標表示.....................(48)
圖5-22由低至高壓施壓下之浮、中、沉之示意圖.................(48)
圖5-23滑脈特徵分析.......................................(50)
圖5-24澀脈特徵分析.......................................(50)
圖5-25弦脈特徵分析.......................................(51)
圖5-26弱脈特徵分析.......................................(51)


表目錄
表5-1壓力值對應數位值與對應電壓值之實際校正量測結果......(36)
表5-2數位值與壓力轉換公式................................(36)
表5-3與脈搏模擬器連接之實測結果統計表....................(37)
表5-4與脈搏模擬器(120/80)連接之實測結果統計表............(38)
表5-5與脈搏模擬器(150/100)連接之實測結果統計表...........(38)
表5-6與脈搏模擬器(200/150)連接之實測結果統計表...........(38)

[1] 費兆馥,＂現代中醫脈診學＂,北京：人民衛生出版社,2003.
[2] 王東生等,”從血流動力學角度探討中醫脈診”,中國中醫急症12卷5期p459,2003
[3] 柳兆榮,”中醫脈象及血流動力學”,自然雜誌,1982
[4] 劉力松、華琦,”脈壓的影響因素及臨床意義”,中國醫刊38卷6期p27-29,2003
[5] 羅志昌、張松、楊益民,”脈搏波的工程分析與臨床應用”,北京:科學出版社,2006
[6] 李崇智、魏凌雲,”人體脈波信號之頻譜分析”, 國立交通大學電子研究所碩士論文,1980
[7] 廖世舉、王唯工,”共振對血壓波與血流波影響之模擬”,國立台灣大學電機工程碩士論文,1991
[8] 石明正、林欽裕,”中醫脈診多脈波訊息感測體之設計與製作”,逢甲大學自動控制工程碩士論文,1997
[9] 許智傑、翁清松,”新型中醫脈診系統之研發與應用”,中原大學醫學工程博士論文,2006
[10] 汪叔游、傅式恩、陳太羲、劉森,”以微電腦分析中醫脈波圖形之軟體設計並以肝炎為例”,中國醫藥大學中醫研究所碩士論文,1976
[11] 張峰碩,”建構非侵入式連續血壓量測系統以評估血管系統之數學模型”,中原大學醫學工程研究所碩士論文,2005.
[12] Joseph J.Carr、John M.Brown”Introduction to Biomedical Equipment Technology Fourth Edition”,Prentice-Hall,2000
[13] http://www.maxim-ic.com/quick_view2.cfm/qv_pk/1845
[14] http://www.fujikura.co.jp/products/electronic/fgn.html
[15] Charles Kitchin,”Biasing and Decoupling Op Amps in Single Supply Application”,ANALOG DEVICES AN-581
[16] Hank Zumbahlen,” Using the Analog Devices Active Filter Design Tool”, ANALOG DEVICES AN-649.
[17] 鄭錦聰,”Matlab程式設計基礎篇”,全華科技,2002.
[18] 許清榮、買大誠,”Visual C# 2005建構資訊系統實戰經典教本,博碩文化,2006.
[19] 章立民研究室,”Visual C# 2005檔案IO與資料存取秘訣,碁峯資訊,2006.
[20] 章立民研究室,”Visual C# 2005程式開發與介面設計秘訣,碁峯資訊,2006.
[21] Adam Nathan著、鄭淑芬譯,”Windows Presentation Foundation新一代使用體驗開發實務”,精誠資訊,2007.
[22] 川西裕幸、高橋忍著、鄧瑋敦譯,”WPF與XAML應用程式開發講座”博碩文化,2007.
[23] 黃俊凱,”血壓量測裝置作業技術規範”,教育部顧問室, 1999.
[24] 范振臺,”可攜式低壓腕部脈搏訊號之量測”,中原大學電機工程研究所碩士論文,2001.
[25] 郭建志,”以恆壓低壓量測連續脈壓訊號＂,中原大學電機工程研究所碩士論文,2002.
[26] 林汶正,＂以可程式微控制系統晶片為基礎之生理訊號監測系統＂中原大學電機工程研究所碩士論文,2003.
[27] Geddes,L.A.,”The Direct and Indirect Measurement of Blood Pressure”,Year Book Medical Publishers,1970.
[28] 廖思堯、李孟澤、蘇昱穎,” 血液與流體力學—脈象”,長庚大學自然科學教學成效提升計畫,2004