臺灣博碩士論文加值系統

血壓在臨床上是用來評估心臟血管狀態的重要參數之一，尤其在加護單位和開刀房中，更是需要即時而且連續地監控血壓波形。事實是，現今臨床上監測連續性血壓最主要還是利用侵入式的動脈導管來達成，這種直接的測量方法雖然可以提供正確而且即時的血壓變化和波形，但是侵入式方法總會帶來相對的風險，例如感染、血管栓塞等，而且有使用設定上的複雜度。光容積波形技術是一種非侵入方式測量方式，用來測量周邊組織血管的容積變化，同是與心臟循環系統有關。因此本研究旨在嘗試利用光容積波形技術之可行性，設計一個能夠簡單使用，以及穩定可靠的非侵入式連續血壓量測系統。

Continuous Blood pressure is one of the most important vital signs to evaluate cardiac-vascular system conditions especially monitoring in intensive care units and operation zones. However, the usage of arterial-line is the most common method of continuous blood pressure measurement. It is measuring real-time blood pressure variations and waveforms directly and reliably, but it neither sets up complex nor is an invasive procedure to induce the risks, like infection or embolism. Photoplethysmography is a non-invasive technology to measure the change of tissue vessel volume concerned with cardiac-vascular system. The aim of research is to find the possibility of developing an easy use, stable, noninvasive, and long term measurement of blood pressure by photoplethysmography.

目 錄
口試委員會審定書.......................................... i
誌謝..................................................... ii
中文摘要................................................ iii
英文摘要................................................ iii
第一章 緒論.............................................. 1
第二章 文獻回顧.......................................... 6
2.1血液動力學Hemodynamics................................ 6
2.1.1血壓和血流......................................... 9
2.1.2血壓調控機制...................................... 17
2.2侵入式血壓量測方法................................... 19
2.2.1動脈導管Arterial line............................. 19
2.3非侵入式血壓量測..................................... 20
2.3.1聽診法 Auscultatory method........................ 21
2.3.2振盪法 Oscillometric method....................... 22
2.3.3血管無負載法 Vascular Unloading Method............ 23
2.3.4動脈張力計法 Arterial Tonometry ...................25
2.3.5脈搏傳遞時間、脈搏傳遞速度........................ 26
2.3.5.1 W. Chen方法................................... 26
2.3.5.2 P. Fung方法................................... 28
第三章 材料與方法....................................... 32
3.1 光容積波形圖Photoplethysmography, PPG原理........... 32
3.2 PPG特徵點選擇 ..................................... 38
3.3 使用設備............................................ 39
3.3.1生理訊號擷取介面.................................. 41
3.3.2 DAQ資料擷取卡及LabVIEW 8.6....................... 43
第四章 實驗結果......................................... 45
第五章 討論與結論....................................... 47


參考文獻................................................. 49

[1] 行政院衛生署國民健康局，高血壓防治手冊--高血壓偵測、控制與治療流程指引，2004

[2] 行政院衛生署，中華民國97年國民醫療保健支出，2009

[3] 行政院衛生署國民健康局，台灣地區高血壓、高血糖、高血脂盛行率調查期末報告，2003

[4] J. S. Williams, S. M. Brown, P. R. Conlin, ”Blood-Pressure Measurement”, N Engl J Med 360: e6, 2009.

[5] J. Allen, “Photoplethysmography and its application in clinical physiological measurement”, Physiol. Meas. 28, R1-R39, 2007.

[6] A.C. Guyton, J.E. Hall, “Guyton & Hall: Textbook of Medical Physiology, 11th edition”, Saunders, 2005.

[7] N. Westerhof, J. W. Lankhaar, B. E. Westerhof, “The arterial Windkessel”, Medical and Biological Engineering and Computing vol.47, p131–141, 2009.

[8] K. H. Parker, “A brief history of arterial wave mechanics” Medical and Biological Engineering and Computing 47, p111–118, 2009.

[9] D. Zheng, A. Murray,” Non-invasive quantification of peripheral arterial volume distensibility and its non-linear relationship with arterial pressure”, Journal of Biomechanics Vol. 42, Issue 8, p1032-1037, 2009.

[10] C. Lahoz, and J.M. Mostaza, “Atherosclerosis as a systemic disease”. Revista Espanola De Cardiologia, 60(2): p. 184-195, 2007.

[11] D. Yadin, von M. Wolf W., N. Michael R., B. Joseph D., “Clinical Engineering- Principles and Applications in Engineering Series” CRC Press, chap.15, 2003.

[12] D. Chemla, J.-L. Teboul, C. Richard, “Noninvasive assessment of arterial pressure”, Current Opinion in Critical Care 14, p317–321, 2008.

[13] P. Holejšovská, Z. Peroutka, J. Čengery, “Non-Invasive Monitoring of the Human Blood Pressure”, Computer-Based Medical Systems, 2003. Proceedings. 16th IEEE Symposium, p301-306, 2003.

[14] K. I. Yamakoshi, H. Shimazu, and T. Togawa, “Indirect measurement of instantaneous arterial blood pressure in the human finger by the vascular unloading technique,” IEEE Trans. Biomed. Eng. , vol. BME-27, No. 3, p150-155, 1980.

[15] G.L. Pressman and P.M. Newgard, “A transducer for the continuous external measurement of arterial blood pressure”, IEEE Trans Bio-Med Electron 10 , p73-81, 1963.

[16] T. Sato, M. Nishinaga, A. Kawamoto, T. Ozawa, and H. Takatsuji, “Accuracy of a Continuous Blood Pressure Monitor Based on Arterial Tonometry”, Hypertension 21, p866-874, 1993.

[17] W. Chen, T. Kobayashi, S. Ichikawa, Y. Takeuchi, T. Togawa, ”Continuous estimation of systolic blood pressure using the pulse arrival time and intermittent calibration”, Med. Biol. Eng. Comput., 38, p569-574, 2000.

[18] P. Fung, G. Dumont, C. Ries, C. Mott and M. Ansermino, “Continuous noninvasive blood pressure measurement by pulse transit time”, in Ann. Int. Conf. IEEE Eng. Med. Biol. Soc., vol.1, p738-741, 2004.

[19] S.R. Alty, N. Angarita-Jaimes, S. C. Millasseau, P. J. Chowienczyk “Predicting Arterial Stiffness From the digital volume pulse waveform” IEEE Transactions on Biomedical Engineering, vol. 54, no. 12, 2007.

[20] M. Nitzan, A. Babchenko, B. Khanokh, “Very low frequency variability in arterial blood pressure and blood volume pulse” Med. Biol. Eng. Comput. 37, p54-58, 1999.

[21] A. Babchenko, E. Davidson, Y. Ginosar, V. Kurz, I. Faib, D. Adler, M. Nitzan, “Photoplethysmographic measurement of changes in total and pulsatile tissue blood volume, following sympathetic blockade”, Physiol. Meas. 22, p389–396, 2001.


[22] J. Ando, A. Kawarada, M. Shibata, K. Yamakoshi, A. Kamiya, “Pressure-volume relationships of finger arteries in healthy subjects and patients with coronary atherosclerosis measured non-invasively by photoelectric plethysmography”, Jpn Circ J., vol.55, p567–75, 1991.

[23] A. Reisner, P. A. Shaltis, D. McCombie, H. H. Asada, “Utility of the Photoplethysmogram in Circulatory Monitoring”, Anesthesiology, vol. 108, No.5, p950-958, 2008.

[24] I. C. Jeong, J. I. Ko, S. O. Hwang, H. R. Yoon, “A New Method to estimate Arterial Blood Pressure using Photoplethysmographic Signal”, Proceedings of the 28th IEEE EMBS Annual International Conference, 2006.

[25] L. B. Cook, “Extracting arterial flow waveforms from pulse oximeter waveforms”, Anaesthesia, vol. 56, Issue 6, p551-555, 2001.

[26] S. C. Millasseaua, J. M. Rittera, K. Takazawa, P. J. Chowienczyk, “Contour analysis of the photoplethysmographic pulse measured at the finger” journal of Hypertension, vol.24, p1449-1456, 2006.

[27] IEEE Standard for Medical Device Communications-Transport Profile-IrDA Based-Cable Connected, IEEE Std 1073.3.2, 2000.

[28] Takuo Aoyagi, “Pulse oximetry: its invention, theory, and future”, Journal of Anesthesia 17, p259–266, 2003.

[29] National Instruments Corporation, ”DAQ E series User manual”.

[30] J. M. Zhang, P. F. Wei and Y. Li, “A LabVIEW Based Measure System for Pulse Wave Transit Time”, International Conference on ITAB, 2008.

[31] Y. Maeda, M. Sekine, T. Tamura, A. Moriya, T. Suzuki, K. Kameyama, ” Comparison of Reflected Green Light and Infrared Photoplethysmography”, 30th Annual International IEEE EMBS Conference Vancouver, British Columbia, Canada, 2008.

[32] P. Shaltis, A. Reisner, H. Asada, “Calibration of the Photoplethysmogram to Arterial Blood Pressure: Capabilities and Limitations for Continuous Pressure Monitoring”, Proceedings of the 2005 IEEE Engineering in Medicine and Biology 27th Annual Conference Shanghai, China, September 1-4, 2005.

[33] I. Jeong, S. Jun, D. Um, J. Oh, H. Yoon, ”Non-Invasive Estimation of Systolic Blood Pressure and Diastolic Blood Pressure Using Photoplethysmograph Components”, Yonsei Med J 51(3): 345-353, 2010.