臺灣博碩士論文加值系統

硬脊膜外麻醉(epidural anesthesia)是目前麻醉最常用的方式，麻醉醫師將麻藥注入硬脊膜外腔(epidural space)，達到半身麻醉的效果。麻醉針所穿刺的生理組織層，由外到內分別為皮膚層-皮下組織-棘上韌帶-棘間韌帶-黃韌帶-硬脊膜外腔，而麻醉醫師最關心，是如何精準到硬脊膜外腔。傳統上的鑑別方式，大多是靠麻醉醫師多年臨床經驗及訓練的手感判斷是否到位。本研究設計一個手持式裝置，利用自動控制的方式，可自動推進，感測穿刺針由黃韌帶至硬脊膜外腔瞬間時即停止。
此設計的概念是根據人體各組織之緻密度不同，而生理訊號不盡相同的特性。設計的方法，我們擷取的生理訊號主要分為力阻抗和電阻抗。實驗的過程中是用豬脊椎做為受測物，觀察穿刺時兩訊號的變化，發現當出現電阻抗訊號上升且同時力阻抗訊號下降時，而控制器偵測到此訊號的變化時即停止馬達，使針尖停在硬脊膜外腔的位置。根據實驗分析的結果定出閥值做為演算法的判斷方式，將此演算法寫入控制器，結合步進馬達完成一套控制系統，用在硬脊膜麻醉。

The purpose of this study was to design a microprocessor-controlled system used in epidural anesthesia. The main components of the system are wire electrode, force detector, steeping motor and related electrical circuits. The changes in electrical impedance and force resistance during needle puncturing were sensed simultaneously. As the needle tip just passed the ligamentum flavum and entering the epidural space, the electrical impedance was suddenly increased and the force resistance was reduced at the same time. The control system detected these changes and stopped the motor automatically. Nineteen tests were preformed in pig phantoms and the success rate was 74% (14/19).

圖目錄...........................................iii
表目錄.......................................... v
中文摘要........................................ vi
Abstract.........................................vii
第一章 緒論 1
1.1 前言 …………………………………………………1
1.2 研究動機與目的 ……………………………………1
1.3 論文架構 ……………………………………………2
第二章 背景介紹 ……………………………………………3
2.1 硬脊膜麻醉的生理特性 ……………………………3
2.2 現行臨床的鑑別方式 ………………………………5
第三章文獻回顧………………………………………………8
3.1 超音波影像 …………………………………………8
3.2 負壓特性 ……………………………………………8
3.3 ”POP”的聲音………………………………………9
3.4 力阻抗………………………………………………10
3.5 電阻抗………………………………………………10
3.6 自動推進平台………………………………………12
第四章實驗方法 ……………………………………………14
4.1生理訊號量測 ………………………………………16
4.2硬體設計 ……………………………………………18
4.2.1微處理機………………………………………22
4.2.2類比數位轉換電路……………………………22
4.2.3機構設計………………………………………24
4.2.4針電極的設計…………………………………27
4.3韌體與軟體分析設計……………………………………31
4.3.18051初始化設定………………………………32
4.3.2類比對數位轉換………………………………35
4.3.3自動偵測系統演算法…………………………37
第五章 實驗結果與討論……………………………………43
5.1豬脊椎穿刺實驗 ………………………………43
5.2討論………………………………………………57
第六章 結論與未來展望……………………………………59
參考文獻…………………………………………………… 61
附錄一 ………………………………………………………62

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