臺灣博碩士論文加值系統

目前疼痛緩解的用藥原則是參照世界衛生組織（WHO）所建議的疼痛緩解三階梯式治療法，即依照不同疼痛程度給予不同劑量與強度的止痛藥劑。因此，疼痛等級的判定即成為用藥的關鍵依據。一般都透過病患主述，或依照疼痛量表的專用格式與數字做為疼痛評估。然而，這樣的方式亦存在不少使用上的缺點或盲點，例如，偽裝、誇大、個別差異性、意識或生理上處於無法正確敘述情況等（如：手術、插管中、昏迷中），皆有必要在醫療上建立另一個客觀的疼痛參考標準。因此本研究之目的是開始發展準確、客觀且定量的疼痛評估方法與設備，並期提供後續疼痛傳導機制及臨床上診斷疼痛和評估治療成效之應用。
　　首先本研究先客觀根據門控理論假設一疼痛傳導機制的新觀念，並初步係針對三種不同刺激方式造成的疼痛，以及同種刺激但造成不同程度的疼痛，利用新研發的微細能量表面肌電圖儀（subtle energy surface electromyography）擷取體表疼痛部位周邊所產生的微細生電訊號，並利用均方根值（root mean square, RMS）、快速傅立葉轉換（fast Fourier transform, FFT）及希爾伯特頻譜（Hilbert spectrum）進行時域、頻域及時頻域之分析。其實驗結果也初步佐證了本研究所提出的疼痛理論假設之合理性。

At present, the guiding principle for pain relief medication is largely based on the WHO suggested 3-step treatment, namely, the pain reliever doses are given in accordance with the subjective feelings of pain of the patient. Accordingly, the discrimination of pain degrees becomes the dominant factor in pain relief medication [1]. In general, such discrimination process heavily relies on the subjective statement of each patient, and is only made quantitative through checking proper level on a pain sheet or circling a proper digit by the patient himself (or herself). However, such a widely used approach is often plagued by drawbacks and oversights, such as: pretending, exaggeration, diversified individual, conditions [2], situations wherein a patient is either mentally or physically unable to provide correct descriptions, etc.
The current research aims to provide an objective approach instead to serve as another reference to the world’s medication practice. To this end, it first proposed a new scheme wherein dermal measurements are to be performed at wherever the pains a patient feels, regardless of how the nerves are physically deployed and signals transmitted beneath the human skin. Then, based on such hypothesis, dermal measurements were taken on 3 kinds of pain stimulations of varying magnitudes on the author’s body, using the self-developed subtle energy surface electromyography. It was evidenced that different kinds of pain could be differentiated through the pain signatures manifested in the temporal behavior (including latency), fast Fourier transform (FFT), and the Hilbert-Huang transformations (HHT) .

摘要 ...............................................i
目錄 ...............................................v
圖目錄 ...............................................vii
表目錄 ...............................................x
第一章 緒論 ......................................1
1.1 前言 ......................................1
1.2 疼痛的基本概念 .............................1
1.2.1 疼痛定義 ......................................1
1.2.2 疼痛耐受力（Pain tolerance） ....................2
1.2.3 多種層面之疼痛經驗 .............................2
1.2.4 疼痛量表介紹 .............................2
第二章 文獻探討 ......................................4
2.1 目前主流的臨床疼痛研究技術 ....................4
2.1.1 腦波圖（EEG） .............................4
2.1.2 腦磁檢測（MEG） .............................4
2.1.3 正電子發射斷層掃描（PET） ....................5
2.1.4　 功能性磁共振成像（fMRI） ....................5
第三章 疼痛理論與量測方法 .............................7
3.1　 人體周邊感受訊號傳遞機制 ....................7
3.1.1　 人體感受器 ..............................7
3.1.2　 疼痛機制與假設 ..............................7
3.3　 實驗方法及流程 .............................10
3.3.1 　實驗架構 ......................................10
3.3.2　 電極位置與疼痛刺激點訊號強度差異性 ...........11
3.3.3　 電極位置與電位向量關係 ....................12
3.4 微細能量訊號放大儀 .............................12
3.5　 頻域分析方式 .............................14
3.5.1　 希爾伯特-黃轉換（HHT）基本理論 ...........14
3.5.2　 即時頻率 .......................................14
3.5.3　 希爾伯特頻譜（Hilbert spectrum）[38] ...........15
第四章 實驗結果與分析 ..............................16
4.1　 導程 V1、V2、V3時域（time domain）分析 ..16
4.1.1 導程V1時域分析與比較 .....................16
4.1.2 導程V2時域分析與比較 .....................19
4.1.3 導程V3時域分析與比較 .....................20
4.2 導程V1、V2、V3頻域（frequency domain）分析 ...23
4.2.1 導程V1頻域分析與比較 .....................23
4.2.2 導程V2頻域分析與比較 .....................25
4.2.3 導程V3頻域分析與比較 .....................27
4.2.4 導程V1、V2、V3積分頻譜斜率比較 ............29
4.3 時頻域分析參數 ..............................34
4.3.1 時域均方根值（RMS）分析與比較 ............34
4.3.2 希爾伯特頻譜（Hilbert spectrum）分析 ............37
第五章　結論 .......................................45
參考文獻 ................................................49
附錄一 ................................................53
Extended Abstract .......................................58
簡歷(CV) ................................................63

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