臺灣博碩士論文加值系統

本論文的研究目的為量測血壓達到提早監測與預防心血管疾病。隨著高齡化社會的來臨，許多慢性疾病皆需要血壓監控來確保病患狀況穩定，但由於市面上較常用的血壓計體積過大，在攜帶上及量測上都較為不便，本論文為了改善現有市面上血壓計為目標，希望將其發展成穿戴式裝置，將其輕量化、微小化，在未來達成與科技產品連接，達到非接觸式、即時監控的量測目標。
本論文以假設在沒有任何外力之下，表層皮膚的變形是來自於其內部血管的壓力波的波動所造成，以此探討相關的幾何結構去驗證其形變量，並且將其結構簡化成較簡易的機械模型去探討皮膚與血壓的關係，藉由應變規所量測的訊號透過模型去反推回內部的血壓壓力值，由於應變規在解析形變量上更為精準，這在微小化的過程中尤其重要。
為了更有效的驗證，本論文建立了一個體外的架構去模擬真實的人體結構，並利用馬達幫浦注水至通道然後改變其供電電壓產生壓力波，並在其人工結構的表面上安置感測器去去驗證其可行度，由結論可得知，內部的壓力波的確會造成皮膚表層的變形，只要能將裝置貼合皮膚順利，即可藉由應變規所量測的訊號反推回內部壓力值，得到即時監控下量測的血壓，
最後，本論文設計了一個簡易的裝置便於使用者穿戴使用，以達到穩定的量測環境，而可以專注在模型的建立推導上，只要能得知人們一般皮膚的機械性質，即可藉由訊號反推回內部血管壓力值。

The objective of this thesis is to develop a blood-pressure measuring method for providing a real-time monitoring and early warning of cardiovascular diseases. The major disadvantages of the commonly-used sphygmomanometers found on the market are bulky and heavy for outdoor applications. In this thesis, we develop a wearable, blood-pressure measuring device with a light weight and small volume.
In this thesis, the proposed noninvasive measuring technique is based on detecting surface deformations of human skins and then calculating the blood pressures. With the assumption of no external forces on the skin surface, the deformation was primarily caused by the fluctuations of the pressure waves in the deeply-embedded arteries surrounded by human tissues. We proposed a simplified mechanical model to convert the surface-skin deformations measured by the strain gauge into the blood pressures of arteries.
For experimental validations, we constructed the artificial human structure composed of the pump and the hollow PDMS tube to analogize the case that a heart pumps out blood pressure waves flowing in arteries. It was demonstrated that the pressure waves in the channel of the PDMS tube could be detected and recorded by the strain gauge attached on the surface of the artificial structure.Then, we developed a prototype for vitro tests with real humans. The experimental results shown that real human blood pressures could be measured with our proposed device with a good accuracy. In the future, the proposed device can be improved by integrating a wireless communication and a microprocessor for portable capabilities.

CONTENTS
口試委員會審訂書 #
誌謝 i
中文摘要 ii
ABSTRACT iii
SYMBOL TABLE iv
CONTENTS v
LIST OF FIGURES vii
LIST OF TABLES xii
Chapter 1. Introduction 1
1.1. Backgrounds and motivation 1
1.2. Overview of the Sphygmomanometer 2
1.3. Thesis organization 8
Chapter 2. Literature review 10
2.1. Blood pressure waveform 10
2.2. Blood pressure measurements 12
2.2.1. Invasive blood measurements 13
2.2.2. Non-invasive blood pressure measurements 14
2.3. Mechanical property of skin tissues 20
Chapter 3. Design of blood-pressure-measuring devices for human fingers 23
3.1. Review of human fingers 23
3.2. Proposed mechanical models of human fingers 26
3.3. Finite element analysis of human fingers 33
Chapter 4. Fabrications and experiment examinations 37
4.1. Device fabrications 37
4.2. Experimental verifications with real human finger 39
4.3. Vitro experiments with the PDMS tube 43
Chapter 5. Experimental results and discussions 50
5.1. Tensile tests of the PDMS tube 50
5.2. Flow tests of the PDMS tube 52
5.2.1. The pumping test with a step voltage function 52
5.2.2. The effect of the normal forces 55
5.2.3. The pressure waves flowing inside the PDMS tube 58
5.3. Experimental verifications with real human finger and data analysis 63
5.4. Discussions 63
Chapter 6. Conclusions and future work 68
6.1. Conclusions 68
6.2. Future work 69
REFERENCE 71

REFERENCE
[1]Ministry of Health and Welfare. (2015, Jun.). 103年國人死因統計結果. [Online]. Available: http://www.mohw.gov.tw/news/531349778
[2]A. J. Ying, H. Arina, B. C. Neal, “Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: a meta-analysis of randomized trials,” Lancet, vol. 385, pp. 867-874, May 2015.
[3]Museum of Health Care. (2013, Apr.). World Health Day 2013 – A short history of sphygmomanometers and blood pressure measurement. [Online]. Available: https://museumofhealthcare.wordpress.com/2013/04/07/world-health-day-2013-a-short-history-of-sphygmomanometers-and-blood-pressure-measurement/
[4]A. Roguin, “Scipione Riva-Rocci and the men behind the mercury sphygmomanometer,” Int. J. Clin. Pract., vol. 60, pp. 73-79, Jan. 2006.
[5]Wikipedia. (2016, Apr.). Sphygmomanometer. [Online]. Available: https://en.wiki pedia.org/wiki/Sphygmomanometer
[6]CNSystems Medizintechnik AG. (2014). Double Finger Sensor – for a quick and easy application. [Online]. Available: http://www.cnsystems.com/products/cnap- monito r-500
[7]K. Ameloot, K. Van De Vijver, O. Broch, N. Van Regenmortel, I. De Laet, K. Schoonheydt, H. Dits, B. Bein, ML. Malbrain, “Nexfin Noninvasive Continuous Hemodynamic Monitoring: Validation against Continuous Pulse Contour and Intermittent Transpulmonary Thermodilution Derived Cardiac Output in Critically III Patients,” The Scientific World Jo., vol. 2013, pp. 1-11, Sep. 2013.
[8]J. Martina, B. Westerhof, J. van Groudever, J. Truijen, Y. Kim, R. Immink, and D. Jobsis, “Noninvasive continuous arterial blood pressure monitoring with Nexfin,” Anaesthesiology, vol. 116, no. 5, pp. 1092–1103, May 2012.
[9]Edwards Lifesciences Corp. (2016). The ClearSight System. [Online]. Available: http://www.edwa rds.com/eu/products/mininvasive/pages/clearsightsystem.aspx
[10]K. H. Wesseling, W. H. Klawer, ” Device for the indirect, non-invasive and continuous measurement of blood pressure,” U.S. Patent 4 406 289, Sep. 27, 1983.
[11]M. Khair, S. Lopez, R. Ng, S. Ghaem, W. Olson, “Optical noninvasive blood pressure sensor and method,” U.S. Patent 6 533 729, Mar. 18, 2003.
[12]R. Chin, P. Mannheimer, R. Flewelling, ” Motion compatible sensor for non-invasive optical blood analysis,” U.S. Patent 6 845 256, Jan. 18, 2005.
[13]C. H. Chen, “The study of the Variation Trend for Diastolic Pressure of the Surgical Patients utilizing Non-Invasive Plethysmography Signal,” M.S. thesis, Dept. Electron. Mech. Eng., Nat. Sun Yay-sen Univ., Kaohsiung, Taiwan, 2004.
[14]C. C. Wei, “An innovative method to measure the peripheral arterial elasticity: Spring constant modeling based on the arterial pressure wave with radial vibration,” Ann. Biomed. Eng., vol. 39, no. 11, pp. 2695–2705, Aug. 2011.
[15]C. Nickson. (2015, Jun.). Arterial Line and Pressure Transducer. [Online]. Available: http://lifeinthefastlane.com/ccc/arterial-line/
[16]R. Raamat, J. Talts, K. Jagomägi, and E. Länsimies, “Mathematical modelling of non-invasive oscillometric finger mean blood pressure measurement by maximum oscillation criterion,” Med. Biol. Eng. Comput., vol. 37, no. 3, pp. 784–788, May 1999.
[17]L. A. Geedes, M. Voelz, C. Combs, D. Reiner, C. F. Babbs,”Characterization of the oscillometric method for measuring indirect blood pressure,” Ann. Biomed. Eng., vol. 10, no. 6, pp. 271-280, 1982.
[18]S. Hocherman and Y. Palti, “Correlation between blood volume and opacity in the finger,” J. Appl. Physiol., vol. 23, no. 2, pp. 157–162, Aug. 1967.
[19]L. W. J. Bogert and J. J. van Lieshout, “Non-invasive pulsatile arterial pressure and stroke volume changes from the human finger,” Exp. Physiol., vol. 90, no. 4, pp. 437–446, Mar. 2005.
[20]B. Saugel, R. Dueck, and J. Y. Wagner, “Measurement of blood pressure,” Best Pract. Res. Clin. Anaesthesiol., vol. 28, no. 4, pp. 309–322, Aug. 2014.
[21]K. Yamakoshi, P. Rolfe, and C. Murphy, “Current developments in non-invasive measurement of arterial blood pressure,” J. Biomed. Eng., vol. 10, no. 2, pp. 130–137, Apr. 1988.
[22]Y. Aizu and T. Asakura, “Bio-speckle phenomena and their application to the evaluation of blood flow,” Opt. Laser Technol., vol. 23, no. 4, Aug. 1991.
[23]K. Shirai, J. Utino, K. Otsuka, and M. Takata, “A novel blood pressure-independent arterial wall stiffness parameter; cardio-ankle vascular index (CAVI),” J. Atheroscler. Thromb., vol. 13, no. 2, pp. 101–107, Aug. 2006.
[24]P. Fung, G. Dumont, C. Ries, C. Mott, and M. Ansermino, “Continuous noninvasive blood pressure measurement by pulse transit time,” in Proc. 26th Annu. Int. Conf. IEEE Engineering in Medicine and Biology Society, San Francisco, CA, 2004, vol. 1, no. 4, pp. 738–741.
[25]P. K. Chiu, “Measurements of Arterial Pulse Wave Velocity Using an Ultrasonic Linear Array,” M.S. thesis, Grad. Inst. Biomed. Electron. Bioinformatics, Nat. Taiwan Univ., Taipei, Taiwan, 2009.
[26]P. E. Nielsen, S.M. Rasmussen, “Indirect Measurement of Systolic Blood Pressure by Strain Gauge Technique at Finger, Ankle and Toe in Diabetic Patients without Symptoms of Occlusive Arterial Disease,” Endocrinol. Metab., vol. 9, no. 1, pp. 25-29, 1973.
[27]P. Salvi, G. Lio, C. Labat, E. Ricci, B. Pannier, and A. Benetos, “Validation of a new non-invasive portable tonometer for determining arterial pressure wave and pulse wave velocity: the PulsePen device,” J. Hypertens., vol. 22, no. 12, pp. 2285–2293, Dec. 2004.
[28]M. Ghaz. (2011, Jan.). Structure and Function of the Skin. [Online]. Available: https://skin-conditions.knoji.com/structure-and-function-of-the-skin/
[29]F. M. Hendriks, D. Brokken, C. W. J. Oomens, F. P. T. Baaijens, and J. Horsten, “Mechanical Properties of Different Layers of Human Skin,” Philips Res. Lab., Dept. Mater. Technol. Eindhoben Univ. Technol., 2000.
[30]G. A. Holzapfel, ”Biomechanics of soft tissue,” The handbook of material behavior nonlinear models and properties, 3th ed., Graz, Austria: LMT-Cachan, 2001, pp. 1049-1063.
[31]N. Magnenat-Thalmann, P. Kalra, J. L. Lévêque, R. Bazin, D. Batisse, and B. Querleux, “A computational skin model: Fold and wrinkle formation,” IEEE Trans. Inf. Technol. Biomed., vol. 6, no. 4, pp. 317–323, Dec. 2002.
[32]L. Huang, N. Bakker, J. Kim, J. Marston, I. Grosse, J. Tis, and D. Cullinane, “A multi-scale finite element model of bruising in soft connective tissues,” J. Forensic Biomech., vol. 3, pp. 1-5, Oct. 2012.
[33]C. Li, G. Guan, R. Reif, Z. Huang, and R. K. Wang, “Determining elastic properties of skin by measuring surface waves from an impulse mechanical stimulus using phase-sensitive optical coherence tomography,” J. R. Soc. Interface, no. 9, vol. 70, pp. 831–841, Nov. 2011.
[34]T. Maeno, K. Kobayashi, and N. Yamazaki, “Relationship between the structure of human finger tissue and the location of tactile receptors,” JSME Int. J., vol. 41, no. 1, pp. 94-100, Mar. 1998.
[35]M. Ursino, and C. Cristalli, “A mathematical study of some biomechanical factors affecting the oscillometric blood pressure measurement,” IEEE Trans. Biomed. Eng., vol. 43, no. 8, pp. 761–778, Aug. 1996.
[36]D. Valdez-Jasso, “Modeling and Identification of Vascular Biomechanical Properties in Large Arteries,” Ph. D. dissertation, Biomathematics, North Carolina Univ., Raleigh, 2010.
[37]J. Habib, L. Baetz, and B. Satiani, “Assessment of collateral circulation to the hand prior to radial artery harvest,” Vasc. Med., vol. 17, no. 5, pp. 352–361, Oct. 2012.
[38]J. Iivarinen, “Diagnostics of human forearm soft tissues using indentation and suction measurements,” Ph. D. dissertation, For. Nat. Sci., Univ. Eastern Finland, Educa, Finland, 2014.
[39]G. Boyer, H. Zahouani, A. Le Bot, and L. Laquièze, “In vivo characterization of viscoelastic properties of human skin using dynamic micro-indentation,” in Proc. 29th Annu. Int. Conf. IEEE EMBS, Lyon, 2007, pp. 4584–4587.
[40]S. H. Woo, Y. Y. Choi, D. J. Kim, F. Bien, and J. J. Kim, “Tissue-informative mechanism for wearable non-invasive continuous blood pressure monitoring,” Sci. Rep., vol. 4, pp. 6618, Oct. 2014.
[41]T. Birch, (2007, Sep.). Continuous Non-Invasive Blood-Pressure Measurements. [Online]. Available: http://www.maths-in-medicine.org/uk/2007/blood-pressure/r eport.pdf
[42]M. Hirai, S. L. Nielsen, and N. A. Lassen, “Blood Pressure Measurement of All Five Fingers by Strain Gauge Plethysmography,” Scand. J. Clin. Lab. Inv., vol. 36, no.7, pp. 627-632, Aug. 1976.
[43]E. Kaniusas, H. Pfützner, L. Mehnen, J. Kosel, J. C. Téllez-blanco, G. Varoneckas, A. Alonderis, T. Meydan, M. Vázquez, M. Rohn, A. M. Merlo, and B. Marquardt, “Method for Continuous Nondisturbing Monitoring of Blood Pressure by Magnetoelastic Skin Curvature Sensor and ECG,” IEEE Sens. J., vol. 6, no. 3, pp. 819–828, Jun. 2006.
[44]H. H. Asada, “Modeling of finger photoplethysmography for wearable sensors,” in Proc. 21st Annu. Int. Conf. IEEE Engineering in Medicine and Biology, Altanta, 1999, vol. 2, pp. 816.
[45]T. Tu, Y. Kao, P. C. Chao, and Y. Lee, “Optimizing A New Blood Pressure Sensor for Maximum Performance Based on Finite Element Model,” in Proc. IEEE Sensors 2014, Valencia, pp. 1873-1876.
[46]J. Solà, S. Castoldi, O. Chételat, M. Correvon, S. Dasen, S. Droz, N. Jacob, R. Kormann, V. Neumann, A. Perrenoud, P. Pilloud, C. Verjus, and G. Viardot, “SpO2 sensor embedded in a finger ring: Design and implementation,” in Proc. 28th IEEE Annu. Int. Conf. Engineering in Medicine and Biology Society, New York, 2006, pp. 4295–4298.
[47]M. Mendlowitz, “Measurements of blood flow and blood pressure in clubbed fingers,” J. Clin. Invest., vol. 20, no. 2, pp. 113, Jul. 1940.
[48]T. Y. Tu, P. C. P. Chao, and Y. P. Lee, “A New Non-Invasive Cuff-Less Blood Pressure Sensor,” in Proc. IEEE Sensors Conf., Baltimore, MD, 2013, no.1, pp. 3-6.
[49]P. Bingger, M. Zens, and P. Woias, “Highly flexible capacitive strain gauge for continuous long-term blood pressure monitoring,” Biomed. Microdevices, vol. 14, no. 3, pp. 573–581, Feb. 2012.
[50]F. De Paoli, “Measuring Polydimethylsiloxane ( PDMS ) Mechanical Properties Using Flat Punch Nanoindentation Focusing on Obtaining Full Contact,” M.S. thesis, Dept. Mech. Eng., Univ. South Florida, Florida, 2015.