臺灣博碩士論文加值系統

親子同室是產婦住院期間與新生兒共處一室，提早學習新生兒的照顧方式，增加親子相處的時間，讓母親方便哺餵母乳及學習育嬰技巧，親子同室可使父母與新生兒有較多親密之接觸，減少新生兒的哭鬧及幫助新生兒有較好的睡眠，但是對於新生兒在親子同室相處期間，對新生兒有好處這個說法在新生兒生理上的變化並無客觀量化之參數，此論文討論以新生兒之心率變異作為新生兒於親子肌膚接觸生理變化給予量化呈現，以量化數據具體說明親子接觸之生理變化。
本論文利用心率變異能量頻譜評估新生兒的睡眠品質探討自主神經在親子同室母子或父子親密接觸時的生理變化作為指標之可行性。因此、發展一套評估新生兒親子肌膚接觸生理指標系統，系統使用單晶片MSP430F6659微控制器作為系統整合擷取新生兒心電圖生理訊號，以USB模組傳輸至電腦，採樣頻率為1000Hz，可即時監測記錄新生兒心電圖，並在紀錄後分析心率變異，以心率變異功率頻譜密度的頻域參數作為新生兒親子親密接觸與否之自主神經生理變化量化指標。
　　實驗採用重複量測之比較性研究以30位親子同室新生兒為研究對象，利用本系統記錄新生兒在獨處及父母懷抱各30分鐘心電訊號傳送至電腦端儲存和分析。以心率變異頻域低頻能量、高頻能量和低頻與高頻能量比值為參數，以成對t-test進行統計分析。在統計結果顯示，新生兒在父母懷抱與無懷抱時，心率變異度的低頻能量無顯著差異，但是在高頻能量和低頻與高頻能量比值皆有顯著差異，顯示副交感神經在親子同室接觸時有顯著安定新生兒作用，藉此臨床量測實驗分析與討論，指出新生兒親子肌膚接觸心率變異度之高頻能量和低頻與高頻能量比值，可量化新生兒肌膚接觸期間自主神經生理指標的可用性。

Rooming-in is the arrangement that allows mothers and newborn babies in the same room during the postpartum hospital stay. This practice gives an opportunity for the parent to have more affectionate touch with their infants. The baby can learn to breastfeed faster and gain weight sooner. Baby sleeps better and fussy less. However, the influence of intimate contact on neonate’s physiological changes has not been studied.
This study has developed a Heart Rate Variability (HRV) evaluation system and reported the neonate physiological changes during parental contact. The system was integrated using a microprocessor (MSP430F6659). It was to acquire one channel of ECG with a USB communication module that will send data to and receive command from a PC. The sample rate of this acquisition device was 1000Hz. The system recorded the electrocardiogram (ECG) in real-time and analyzed the heart rate variability.
Thirty healthy neonates were recruited and a repeated measure comparative study was conducted in this study. The HRV power spectrum in high and low frequency bands were calculated and compared for babies with and without parental holding. For each subject, 30 minutes of ECG was obtained by our system at mother’s holding, father’s holding and without any holding, respectively. The HRV parameters calculated were low frequency (LF) power, high frequency (HF) power and LF/HF. The paired t-test was used for statistical analysis and p<0.05 is considered statistically significant. The result of statistical analysis showed compared HRV parameters of baby with and without parental holding, the HF power and LF/HF ratio were both significant (P<0.05). However, there was no significant difference at LF power. This result showed that the parasympathetic nerve system has shown a significant difference that improved the stability of neonatal status at intimate contact of baby.
This research has designed and implemented an evaluation system for neonate physiological index. The system can make available reference to parent with a long-term monitoring and recording of their neonate physiological information.

目錄
摘要 I
Abstract II
致謝 IV
目錄 V
圖目錄 VII
表目錄 XI
第一章 緒論 1
1-1前言 1
1-2文獻回顧 2
1-3研究目的 4
1-4論文架構 4
第二章 研究背景與原理 5
2-1新生兒護理 5
2-1-1新生兒的界定 5
2-1-2阿帕嘉計分(Apgar Score)評估表 5
2-1-3出生時循環系統的改變(circulatory changes occurring at birth) 6
2-1-4血壓及心輸出量 7
2-1-5肺臟功能 8
2-1-6新生兒的心電圖 9
2-2心電圖簡介 10
2-3心率變異度(Heart rate variability, HRV) 14
2-3-1心率變異度與自主神經系統 15
2-3-2心率變異度與呼吸頻率 18
2-3-3心率變異度分析 19
2-3-4心率變異度頻譜意義 21
2-4 QRS波特徵點的偵測 23
2-5心跳間期重新取樣(Berger algorithm) 24
2-6快速傅立葉轉換 25
2-7本章總結 26
第三章 實驗架構與方法 27
3-1硬體架構與裝置概述 28
3-2生理訊號擷取類比電路 29
3-2-1儀表放大器 29
3-2-2類比濾波電路處理 30
3-2-3放大及減法器 32
3-3 MSP430微控制器 32
3-4通用串列匯流排(USB) 33
3-5軟體接收介面設計 34
3-6心電圖數位訊號處理 35
3-7本章總結 36
第四章 實驗結果與討論 37
4-1 ECG類比訊號截取電路 37
4-2前端硬體設計 37
4-3心電圖訊號擷取視窗 38
4-4心電訊號處理與驗證 39
4-4-1 ECG訊號特徵化 39
4-4-2 R-R間隔資料重新取樣 41
4-4-3快速傅立葉轉換驗證 42
4-4-4實際心電訊號量測處理 44
4-5實驗資料收集 45
4-6實驗分析與實驗討論 48
4-6-1實驗資料收集的時間與限制 48
4-6-2實驗資料分析參數與生理的相關性 48
4-6-3實驗資料統計結果 49
4-6-4實驗資料分析討論 53
4-6-5量測期間聲音干擾的影響 54
4-6-6量測期間環境溫度的影響 55
4-6-7量測期間母乳哺餵的影響 57
4-7本章總結 58
第五章結論與未來展望 60
5-1實驗現況與困難 60
5-2結論 61
5-3未來展望 61
第六章 參考文獻 62
附錄1台中慈濟醫院研究計畫許可證明書 67
附錄2台中慈濟醫院研究計畫許可證明書 英文版 68
附錄3新生兒親子同室心率變異分析圖 69

圖目錄
圖2-1-3出生後新生兒的循環[9] 7
圖2-1-4出生後的心率和血壓[7] 8
圖2-1-5出生後新生兒的肺壓力-體積曲線[9] 9
圖2-1-6-1利用心電圖導程Ｉ所量測到的新生兒右心室肥大之心電圖 9
圖2-1-6-2小兒各年齡之心率[11] 10
圖2-2-1心電圖之傳導結構[12] 11
圖2-2-2 Bipolar leads(雙極誘導)及Einthoven正三角形[13] 13
圖2-2-3標準肢導程(The Standard Limb Leads)[13] 14
圖2-3-1自主神經系統。紅色表是交感分支；藍色表示副交感分支；實線表示節前神經元；虛線表示節後神經元[15] 18
圖2-3-3心率變異度頻譜[16] ，(a)心率變異度頻譜主要的三個頻峰，(b) 副交感神經抑制時之頻譜。 21
圖2-4 QRS波特徵化處理程序流程圖 24
圖2-5 Berger演算法示意圖[23]，利用此法將RR間距（a）轉換成等距取樣心率訊號（b）其中在t1，t2振幅決定的方式分別為a/I2，b/I3+c/I4（c）重新取樣頻率。 25
圖3實驗量測裝置示意圖 28
圖3-1以MSP430為核心之系統架構圖 29
圖3-2 心電圖類比訊號方塊圖 29
圖3-2-1 INA 128功能接腳圖[28] 30
圖3-2-2-1實現之二階butterworth高通濾波器之線路 30
圖3-2-2-2實現之四階butterworth低通濾波器之線路 31
圖3-2-2-3實現之60Hz T型帶拒濾波器之線路 31
圖3-2-3正向放大及減法器線路 32
圖3-3 MSP430F6659腳位圖[29] 33
圖3-4 PL2303之通訊應用設計電路圖 34
圖3-5超級終端機接收資料結果 35
圖4-1-1鈕扣式心電圖電極貼片 圖4-1-2ECG類比訊號模組 37
圖4-2前端硬體設計模組，尺寸為135cm、75 cm、38 cm 38
圖4-3 Borland C++ Builder心電圖訊號傳輸顯示介面 39
圖4-4-1-1原始ECG訊號 40
圖4-4-1-2利用數位高通、低通濾波處理後之波形 40
圖4-4-1-3微分取絕對值處理後之波形 40
圖4-4-1-4經過平滑處理後之波形 40
圖4-4-1-5設閥值取R波位置之結果 41
圖4-4-2-1原始R-R interval訊號 41
圖4-4-2-2經過重新取樣處理後的R-R interval訊號 41
圖4-4-3-1 Sine wave 5Hz的測詴訊號 42
圖4-4-3-2驗證Sine wave 5Hz FFT的頻率響應 43
圖4-4-3-3 Sine wave 5Hz與50Hz混合測詴訊號 43
圖4-4-3-4驗證Sine wave 5Hz與50Hz FFT的頻率響應 43
圖4-4-4新生兒心電訊號分析結果之代表例 45
Subject1新生兒單獨休息心電訊號分析圖 69
Subject1新生兒母嬰肌膚接觸休息心電訊號分析圖 69
Subject1新生兒父嬰肌膚接觸休息心電訊號分析圖 70
Subject2新生兒單獨休息心電訊號分析圖 70
Subject2新生兒母嬰肌膚接觸休息心電訊號分析圖 71
Subject2新生兒父嬰肌膚接觸休息心電訊號分析圖 71
Subject3新生兒單獨休息心電訊號分析圖 72
Subject3新生兒母嬰肌膚接觸休息心電訊號分析圖 72
Subject3新生兒父嬰肌膚接觸休息心電訊號分析圖 73
Subject4新生兒單獨休息心電訊號分析圖 73
Subject4新生兒母嬰肌膚接觸休息心電訊號分析圖 74
Subject4新生兒父嬰肌膚接觸休息心電訊號分析圖 74
Subject5新生兒單獨休息心電訊號分析圖 75
Subject5新生兒母嬰肌膚接觸休息心電訊號分析圖 75
Subject5新生兒父嬰肌膚接觸休息心電訊號分析圖 76
Subject6新生兒單獨休息心電訊號分析圖 76
Subject6新生兒母嬰肌膚接觸休息心電訊號分析圖 77
Subject6新生兒父嬰肌膚接觸休息心電訊號分析圖 77
Subject7新生兒單獨休息心電訊號分析圖 78
Subject7新生兒母嬰肌膚接觸休息心電訊號分析圖 78
Subject7新生兒父嬰肌膚接觸休息心電訊號分析圖 79
Subject8新生兒單獨休息心電訊號分析圖 79
Subject8新生兒母嬰肌膚接觸休息心電訊號分析圖 80
Subject8新生兒父嬰肌膚接觸休息心電訊號分析圖 80
Subject9新生兒單獨休息心電訊號分析圖 81
Subject9新生兒母嬰肌膚接觸休息心電訊號分析圖 81
Subject9新生兒父嬰肌膚接觸休息心電訊號分析圖 82
Subject10新生兒單獨休息心電訊號分析圖 82
Subject10新生兒母嬰肌膚接觸休息心電訊號分析圖 83
Subject10新生兒父嬰肌膚接觸休息心電訊號分析圖 83
Subject11新生兒單獨休息心電訊號分析圖 84
Subject11新生兒母嬰肌膚接觸休息心電訊號分析圖 84
Subject11新生兒父嬰肌膚接觸休息心電訊號分析圖 85
Subject12新生兒單獨休息心電訊號分析圖 85
Subject12新生兒母嬰肌膚接觸休息心電訊號分析圖 86
Subject12新生兒父嬰肌膚接觸休息心電訊號分析圖 86
Subject13新生兒單獨休息心電訊號分析圖 87
Subject13新生兒母嬰肌膚接觸休息心電訊號分析圖 87
Subject13新生兒父嬰肌膚接觸休息心電訊號分析圖 88
Subject14新生兒單獨休息心電訊號分析圖 88
Subject14新生兒母嬰肌膚接觸休息心電訊號分析圖 89
Subject14新生兒父嬰肌膚接觸休息心電訊號分析圖 89
Subject15新生兒單獨休息心電訊號分析圖 90
Subject15新生兒母嬰肌膚接觸休息心電訊號分析圖 90
Subject15新生兒父嬰肌膚接觸休息心電訊號分析圖 91
Subject16新生兒單獨休息心電訊號分析圖 91
Subject16新生兒母嬰肌膚接觸休息心電訊號分析圖 92
Subject16新生兒父嬰肌膚接觸休息心電訊號分析圖 92
Subject17新生兒單獨休息心電訊號分析圖 93
Subject17新生兒母嬰肌膚接觸休息心電訊號分析圖 93
Subject17新生兒父嬰肌膚接觸休息心電訊號分析圖 94
Subject18新生兒單獨休息心電訊號分析圖 94
Subject18新生兒母嬰肌膚接觸休息心電訊號分析圖 95
Subject18新生兒父嬰肌膚接觸休息心電訊號分析圖 95
Subject19新生兒單獨休息心電訊號分析圖 96
Subject19新生兒母嬰肌膚接觸休息心電訊號分析圖 96
Subject19新生兒父嬰肌膚接觸休息心電訊號分析圖 97
Subject20新生兒單獨休息心電訊號分析圖 97
Subject20新生兒母嬰肌膚接觸休息心電訊號分析圖 98
Subject20新生兒父嬰肌膚接觸休息心電訊號分析圖 98
Subject21新生兒單獨休息心電訊號分析圖 99
Subject21新生兒母嬰肌膚接觸休息心電訊號分析圖 99
Subject21新生兒父嬰肌膚接觸休息心電訊號分析圖 100
Subject22新生兒單獨休息心電訊號分析圖 100
Subject22新生兒母嬰肌膚接觸休息心電訊號分析圖 101
Subject22新生兒父嬰肌膚接觸休息心電訊號分析圖 101
Subject23新生兒單獨休息心電訊號分析圖 102
Subject23新生兒母嬰肌膚接觸休息心電訊號分析圖 102
Subject23新生兒父嬰肌膚接觸休息心電訊號分析圖 103
Subject24新生兒單獨休息心電訊號分析圖 103
Subject24新生兒母嬰肌膚接觸休息心電訊號分析圖 104
Subject24新生兒父嬰肌膚接觸休息心電訊號分析圖 104
Subject25新生兒單獨休息心電訊號分析圖 105
Subject25新生兒母嬰肌膚接觸休息心電訊號分析圖 105
Subject25新生兒父嬰肌膚接觸休息心電訊號分析圖 106
Subject26新生兒單獨休息心電訊號分析圖 106
Subject26新生兒母嬰肌膚接觸休息心電訊號分析圖 107
Subject26新生兒父嬰肌膚接觸休息心電訊號分析圖 107
Subject27新生兒單獨休息心電訊號分析圖 108
Subject27新生兒母嬰肌膚接觸休息心電訊號分析圖 108
Subject27新生兒父嬰肌膚接觸休息心電訊號分析圖 109
Subject28新生兒單獨休息心電訊號分析圖 109
Subject28新生兒母嬰肌膚接觸休息心電訊號分析圖 110
Subject28新生兒父嬰肌膚接觸休息心電訊號分析圖 110
Subject29新生兒單獨休息心電訊號分析圖 111
Subject29新生兒母嬰肌膚接觸休息心電訊號分析圖 111
Subject29新生兒父嬰肌膚接觸休息心電訊號分析圖 112
Subject30新生兒單獨休息心電訊號分析圖 112
Subject30新生兒母嬰肌膚接觸休息心電訊號分析圖 113
Subject30新生兒父嬰肌膚接觸休息心電訊號分析圖 113

表目錄
表2-1阿帕嘉計分(Apgar Score)評估表內容 6
表2-2心率變異頻譜意義[20] 22
表4-1 30位新生兒基本資料與特徵 47
表4-2 30位受測者在三種不同的睡眠環境下心率變異度的參數 51
表4-3 新生兒在單獨、母嬰接觸、父嬰接觸的睡眠環境下，用t-test統計分析LF能量成分的結果(n=30) 52
表4-4 新生兒在單獨、母嬰接觸、父嬰接觸的睡眠環境下，用t-test統計分析HF能量成分的結果(n=30) 52
表4-5 新生兒在單獨、母嬰接觸、父嬰接觸的睡眠環境下，用t-test統計分析LF/HF能量比值的結果(n=30) 52

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