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研究生:王琡惠
研究生(外文):Shu-huei Wang
論文名稱:糖尿病周邊血管機械性質之分析
論文名稱(外文):Analysis of the Mechanical Properties of Peripheral Arteries of Diabetes
指導教授:邵耀華
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:應用力學研究所
學門:工程學門
學類:機械工程學類
論文種類:學術論文
論文出版年:1999
畢業學年度:87
語文別:中文
論文頁數:87
中文關鍵詞:周邊動脈糖尿病EDR
外文關鍵詞:peripheral arteriesdiabeticEDR
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本研究主要利用特製夾具結合臨床超音波與觸診式壓力計進行非侵入式之同步量測,使用影像處理軟體分析超音波影像以研究周邊動脈之機械性質。由於糖尿病病徵多發生於周邊動脈,本實驗提出一代表血管能量耗損之參數EDR,可探討年齡及糖尿病對周邊動脈之影響。
實驗對象分為年輕、非糖尿病之老年組及糖尿病三組,量測平躺及坐立時之血管性質,觀察姿態改變後血管的因應性及自主神經之控制能力。由結果發現隨著年齡增加,足背動脈的應變減小(8.91±0.88% vs. 6.96±1.95%, p<0.01),楊氏係數增大(0.90±0.11 ×106dyne/cm2 vs. 1.51±0.39 ×106dyne/cm2, p<0.01),EDR增加(5.60±1.29% vs. 8.08±1.61%, p=0.21)。年輕組在姿態改變的變化較明顯,可能是由於年齡增加而造成下肢動脈之交感神經變差。
糖尿病組之血壓普遍較非糖尿病組高,在上肢血管(BA & RA)的應變量減小,楊氏係數增加,而足背動脈的應變量變小(6.96±1.95% vs. 6.36±2.05%, p=0.38),楊氏係數增加(1.51±0.39×106dyne/cm2 vs. 1.61±0.43×106dyne/cm2, p=0.3),且EDR明顯增加(8.08±1.61% vs. 11.51±2.07%, p=0.09),顯示下肢動脈受疾病的影響較大。非糖病組姿態改變後管俓之收縮量大於糖尿病組,DP的管壁脈動變化較明顯。糖尿病組姿態改變後,下肢管徑的變化量不明顯,壓力並沒有增加,表示其腿部交感神經束的作用已經變差。

In this study, we developed a fixture that incorporated an applanation tonometry with high-resolution ultrasound to measure non-invasively the mechanical properties of peripheral arteries (brachial artery, BA, radial artery, RA and dorsalis pedis artery, DPA) via image post-processing. Since the diabetic patients are often associated with peripheral arterial diseases, we propose a new parameter, energy dissipation ratio (EDR), that characterize the viscoelastic properties of arteries for the quantification of vascular diseases.
The subjects studied were divided into three groups, young, diabetic patients and their age-matched control group. Postural change was adopted to investigate the vascular muscle tone and sympathetic response of peripheral arteries. Results show that the vessel distensibility at the DPA decrease substantially with age (8.91±0.88% vs. 6.96±1.95%, p<0.01), the corresponding arterial elastic modulus increase (0.90±0.11 Mdyne/cm2 vs. 1.51±0.39 Mdyne/cm2, p<0.01) and the EDR increase (5.60±1.29% vs. 8.08±1.61%, p=0.21). The arterial mechanical properties of young group reacted more effectively to the postural variation, which suggested that the autonomic function in the lower extremity would decay with age.
The DM patients have higher mean arterial pressure than the control group, their peripheral arterial distensibility decrease, the pressure-diameter elastic modulus increase and the EDR increase notably (DPA: 11.51±2.07% vs. 8.08±1.61%, p=0.09). The peripheral artery in the lower extremity of DM patient seems to be influenced more significantly by the circulatory diseases than the blood vessels in the upper trunk. The age-matched control group shows higher DPA diameter reduction than that of DM patient after changing from supine to sit. The DPA vessel diameter and blood pressures of DM subjects were less affected by the postural change, this signifies the lost or degeneration of sympathetic tone in diabetic foot.

第一章 緒  論 1
1-1 前  言 1
1-2 文獻回顧2
1-3 研究動機及目的5
1-4 論文架構6
第二章 研究原理7
2-1 醫用超音波原理7
2-2 血管的機械性質10
2-3 糖尿病理學14
2-3-1 糖尿病分類及病因14
2-3-2 糖尿病之併發症14
2-4 周邊動脈疾病之學理檢查18
第三章 實驗方法及設備20
3-1 實驗方法簡述20
3-1-1 管徑之量測法21
3-1-2 血壓脈波之量測法21
3-2 實驗設備23
3-3 系統校正24
3-3-1 壓力計訊號驗證24
3-3-2 彈性系統之校正25
3-3-3 壓力計量測誤差校正25
3-4 實驗對象26
3-5 實驗步驟27
3-5-1 靜態量測27
3-5-2 姿態改變量測28
3-5-3 溫度改變實驗28
3-6 資料分析與處理29
第四章 結果與討論31
4-1 誤差校正結果31
4-1-1 壓力計訊號號驗證結果31
4-1-2 夾具誤差校正結果32
4-1-3 系統訊號誤差校正結果32
4-1-4 壓力計誤差33
4-1-5 影像處理誤差之校正結果35
4-2 年齡對血管機械性質之影響36
4-2-1 年齡對血壓之影響36
4-2-2 年齡對管徑及脈動之影響37
4-2-3 年齡對EDR之影響39
4-2-4 年齡對姿態改變後血管機械性質之影響39
4-3 糖尿病對血管機械性質之影響41
4-3-1 糖尿病對血壓之影響41
4-3-2 糖尿病對管徑及脈動之影響43
4-3-3 糖尿病對EDR之影響44
4-3-4 糖尿病對姿態改變時血管機械性質之影響45
4-4 溫度改變對糖尿病組之影響47
4-5 交感神經之作用47
4-6 EDR之意義48
第五章 結論與未來展望51
5-1 結  論51
5-2 未來展望52

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