臺灣博碩士論文加值系統

硬脊膜外腔麻醉術是臨床上常見的麻醉術，由麻醉醫師將硬膜外麻醉針刺進狹窄的硬脊膜外腔內，放置導管並注入麻藥。若穿刺過深誤刺穿硬脊膜，使得腦脊髓液流出，將導致患者劇烈頭痛並引發後遺症。
本團隊開發30 MHz高頻超音波探針技術，在硬膜外麻醉針的內部空間中置入超音波探針，提供硬膜外麻醉針的導引與定位。
本研究針對先前團隊所發展的高頻超音波探針技術進行改良，將超音波探頭面積提升40%，以提高探針效能。製程時間由原先7天縮短至3天，提高製作效率。並將前視訊號改為側向影像，使所能掃描的範圍更廣。利用B-mode即時呈現穿刺路徑中，各穿刺階段的組織亮度，用以區分目前針尖位置，有助於麻醉醫生即時判斷，以防止硬脊膜被刺穿。並透過馬達旋轉探針，收取硬脊膜外腔內影像，協助了解腔內構造。

Epidural Anesthesia (EA) is one of the most common anesthesia methods. The anesthesiologist will insert the epidural needle, place catheter and inject anesthetic into the narrow epidural space. Too deep needle insertion would cause Dural Puncture which result in Cerebral Spinal Fluid (CSF) leakage with headache and vomit complications etc.
We develop a 30 MHz high-frequency ultrasound needle transducer technology, place the needle transducer into the epidural needle and is able to provide guiding and locating in EA insertion.
In this research, the 40% increase of transducer active area improves the sensitivity of ultrasound needle. We design a new and efficient process. And the time of needle fabrication is shortened from original 7 days to 3 days. The change from front sight to side scanning extends more range of vision. With real-time B-mode showing the brightness of different part of tissue in insertion path way, anesthetists can distinguish the location of the needle tip and prevent Dural Punctured.

誌謝………………………………………………………………………………….… i
摘要…………………………………………………………………………………... ii
Abstract………………………………………………………………………………. iii
目錄…………………………………………………………………………...……… iv
圖目錄………………………………………………………………………………. vii
表目錄……………………………………………………………………………..….. x
第一章 緒論 1
1.1 前言 1
1.2 相關文獻回顧 3
1.3 研究動機 5
1.4 論文架構 6
第二章 理論基礎 7
2.1 超音波原理 7
2.2 超音波的反射與折射 9
2.3 超音波的吸收與衰減 10
2.4 超音波探頭 11
2.5 超音波顯像模式 14
2.6 超音波解析度 16
2.7 超音波能量 17
2.8 阻抗匹配 19
第三章 材料與方法 20
3.1 探頭製作 20
3.2 探針製作 23
3.2.1 材料準備 23
3.2.2 探頭封裝 24
3.2.3 清潔及保護 26
3.2.4 探針極化 26
3.3 探針效能評估 27
3.3.1 回波訊號量測 27
3.3.2 聲場量測 28
3.3.3 阻抗分析 29
3.4 LABVIEW成像 31
3.5 步進馬達 32
3.6 動物實驗架構 33
第四章 實驗結果 34
4.1 超音波探針製作結果 34
4.1.1 回波訊號量測分析 34
4.1.2 聲場量測分析 36
4.1.3 阻抗分析 38
4.2 動物實驗結果 41
第五章 實驗結果與討論 46
5.1 超音波探針製作結果討論 46
5.1.1 品質管理及定量化 46
5.1.2 保護層增厚 46
5.1.3 與原製程比較 47
5.2 動物實驗結果討論 49
5.2.1 B-mode灰階值 49
5.2.2 成像雜訊 49
第六章 結論與未來展望 51
6.1 結論 51
6.2 未來展望 52
參考文獻 53

圖目錄
圖1-1 脊椎結構斜視圖[4] 1
圖1-2 硬脊膜外腔麻醉穿刺示意圖[6] 2
圖1-3 使用Epidrum定位硬脊膜外腔[15] 4
圖2-1 入射強度、反射強度與折射強度之間的關係 9
圖2-2 超音波探頭等效電路[25] 11
圖2-3 超音波探頭構造 11
圖2-4 壓電效應[27] 13
圖2-5 超音波A-mode成像[26] 14
圖2-6 A-mode與B-mode關係圖[28] 15
圖2-7 (a)橫向解析度，(b)軸向解析度 16
圖2-8 聲場分布情形[20] 17
圖2-9 聲場量測方塊圖 18
圖2-10 ISPPA取樣時間[30] 18
圖2-11 變壓器 19
圖3-1 利用PiezoCAD軟體模擬之超音波回波頻譜圖 22
圖3-2 利用PiezoCAD軟體模擬之超音波回波頻譜圖 22
圖3-3 雷射鑽孔架構圖 24
圖3-4 導電膠式探針製作步驟 25
圖3-5 鍍金式探針製作步驟 25
圖3-6 壓電晶體極化過程: (a)極化前，(b)極化後 26
圖3-7 高電壓電源供應器 26
圖3-8 超音波探針回波訊號量測架設圖 27
圖3-9 回波訊號量測儀器:(a)5900PR，(b)示波器 28
圖3-10 回波訊號頻譜圖 28
圖3-11 聲場量測架設圖 29
圖3-12 聲場量測儀器:(a)AVTECH，(b)水聽器 29
圖3-13 阻抗分析量測圖 30
圖3-14 阻抗分析量測架設圖 30
圖3-15 阻抗分析儀器圖:(a)阻抗分析儀，(b)阻抗匹配電路 30
圖3-16 A-mode轉換成B-mode 31
圖3-17 LabVIEW成像介面圖 31
圖3-18 步進馬達 32
圖3-19 馬達控制架設圖 32
圖3-20 LabVIEW成像介面圖與馬達開關 32
圖3-21 動物實驗系統架設圖 33
圖4-1 超音波探針實體圖 34
圖4-2 超音波探針側面圖:(a)鍍金式探針，(b)導電膠式探針 34
圖4-3 探頭表面圖:(a)導電膠式，(b)鍍金式 36
圖4-4 探針回波訊號頻譜圖:(a)導電膠式，(b)鍍金式 36
圖4-5 能量分析圖 37
圖4-6 匹配前後阻抗分析圖:(a)匹配前，(b)匹配後 39
圖4-7 回波訊號圖:(a)匹配前，(b)匹配後 40
圖4-8 (a)進行穿刺時背部需拱起，(b)脊髓掃描圖 41
圖4-9 豬脊髓結構B-mode影像 41
圖4-10 穿刺示意圖 42
圖4-11 穿刺路徑示意圖 42
圖4-12 腰椎第二節穿刺結果 43
圖4-13 腰椎第三節穿刺結果 43
圖4-14 探針後端連接馬達 44
圖4-15 硬膜外麻醉針與超音波探針 44
圖4-16 超音波探針在硬膜外麻醉針內掃描之強反射訊號 44
圖4-17 超音波探針在硬脊膜外腔裡掃描之影像 45
圖5-1 硬膜外麻醉針刮除保護層 47
圖5-2 探頭擺設位置:(a)前向探針，(b)側向探針 47
圖5-3 探頭實體圖:(a)前向探針，(b)側向探針 48
圖5-4 MATLAB設計簡易濾波器濾除雜訊 50
圖5-5 濾波前與濾波後影像比對:(a)濾波前，(b)濾波後 50

 
表目錄
表2-1 介質密度與聲速、特性阻抗[21] 8
表2-2 1 MHz超音波衰減係數[24] 10
表3-1 壓電晶體PMN-PT相關參數[31] 20
表3-2 PiezoCAD軟體設計30 MHz探頭相關參數 21
表3-3 聲阻抗值與電性參數 21
表3-4 30 MHz晶體之匹配層、墊背層材料與參數設定 21
表3-5 各式材料及規格表 23
表3-6 5900PR設定參數 27
表4-1 超音波探針-回波訊號數據分析 35
表4-2 超音波探針-回波訊號平均數據分析 35
表4-3 超音波探針-聲場量測數據分析 37
表4-4 探針G6聲場量測之參數 38
表4-5 超音波探針-阻抗分析數據 38
表4-6 超音波探針-阻抗分析平均數據 38
表4-7 阻抗匹配前後探針參數 39
表5-1 探針振幅等級分類 46
表5-2 B-mode灰階值分析 49

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