臺灣博碩士論文加值系統

中文摘要

腦血管疾病近年來一直是國內十大死因的前三名[1]，而腦血流自動調控機制是關係著腦血管疾病發作的重要因子。但目前偵測腦血流所使用的設備﹙如：磁共振造影儀、正子射出斷層攝影儀等﹚皆是十分昂貴且所擷取的腦血流訊號非但不能連續擷取，更不易完成動態的檢查動作﹙如：起站的動作﹚，如果使用成本較低的穿顱都卜勒超音波，即能達到即時、連續擷取且較易完成動態的檢查動作。故本研究的目的是利用非侵入的檢測方式觀察血壓與腦血流之間的變化關係，進而探討腦血流自動調控機制之調控模式。以正常人、糖尿病無神經病變病人及糖尿病有神經病變病人各10位為實驗對象，受測者以平躺與被動搖起的姿勢，使用穿顱超音波連續擷取中大腦動脈之腦血流訊號，以及使用經指連續血壓脈搏計連續擷取手指之連續脈波訊號量測，針對腦血流自動調控機制的線性部份進行各項時域、頻域及時-頻域的分析。
從時域的結果顯示，糖尿病有神經病變病人其平均血壓 (平躺：91.55□14.85 mmHg，被動搖起：74.12□13.35 mmHg) 在被動搖起時明顯的下降了，而正常人的平均血壓(平躺：88.83□9.17 mmHg，被動搖起：93.97□11.39 mmHg)則無此結果。除此之外，群化分析結果也顯示，糖尿病有神經病變病人之平均血壓與平均腦血流速分佈群間的距離量測結果(平躺分佈群至被動搖起平均的距離：20.00□6.22，被動搖起分佈群至平躺平均的距離：20.10□6.09，平躺平均至被動搖起平均的距離：19.71□6.17)均比正常人(平躺分佈群至被動搖起平均的距離：12.45□6.00，被動搖起分佈群至平躺平均的距離：12.66□5.70，平躺平均至被動搖起平均的距離：10.88□7.00)大。而觀察腦血流自動調控曲線分析結果，糖尿病有神經病變的病人(平躺平均至被動搖起平均的斜率結果：1.34□2.66)也比正常人(平躺平均至被動搖起平均的斜率結果：0.87□0.82)大。另外，在頻域的分析結果亦顯示，糖尿病有神經病變的病人其不論是平均血壓或是平均腦血流速的變動均比正常人小。綜合各項線性分析結果均顯示正常人與糖尿病病人有明顯的差異，而這些結果對於未來的臨床研究有正面的價值。我們也期望將來可以將此研究運用到臨床診斷上，提供醫師在診斷腦血管疾病的參考指標。

Abstract

In recent years, stroke is the third leading cause of mortality in Taiwan. One of the most important factors contributing to stroke is the regulation of cerebral blood flow (CBF) which is influenced by cerebral autoregulation (CA). Most of clinical instruments for detecting CBF (such as MRI, PET) are very expensive and not suitable for continuous movement. In this study, the arterial blood pressure (ABP) and cerebral blood flow velocity (CBFV) were continuously measured by Finapres and transcranial Doppler (TCD) respectively during the supine and tilt-up positions. The mean arterial blood pressure (MABP) and mean cerebral blood flow velocity (MCBFV) time series were calculated. Ten healthy adults, ten diabetes without autonomic neuropathy, and ten with autonomic neuropathy (sex and age matched) were examined in this study. The CA model was analyzed by linear analysis in time-domain, frequency-domain and time-frequency domain of clinical real-time data of ABP and CBF. The main purpose of this study is to use noninvasive and signal processing techniques to observe the fluctuations between the ABP and CBFV.
The results of time-domain analysis show that MABP of diabetic autonomic neuropathy (DAN) (supine：91.55□14.85 mmHg, tilt-up：74.12□13.35 mmHg) decrease significantly during tilt-up than that of healthy adults (supine：88.83□9.17 mmHg, tilt-up：93.97□11.39 mmHg). In addition, the results of cluster analysis based on distance measurement using the scattered plot between MABP and MCBFV show that DAN (supine－tilt-up mean：20.00□6.22, tilt-up－supine mean：20.10□6.09, supine mean－tilt-up mean：19.71□6.17) larger than healthy adults (supine－tilt-up mean：12.45□6.00, tilt-up－supine mean：12.66□5.70, supine mean－tilt-up mean：10.88□7.00). To observe the results of autoregulation curve analysis, the slope of DAN (slope between supine mean－tilt-up mean：1.34□2.66) also larger than healthy adults (slope between supine mean－tilt-up mean：0.87□0.15). Finally, the results of frequency-domain analysis show that the fluctuations of DAN both in MABP and MCBFV are significantly smaller than that of healthy adults. It can obtain similar results form other linear analysis. Linear analysis exhibits significantly different between healthy adults and DAN. The results are helpful for clinical practice and can provide critical information for physicians.
Keywords：cerebral autoregulation, noninvasive, linear analysis

目錄
中文摘要i
Abstractiii
感謝v
目錄vi
圖目錄ix
表目錄xi
第一章 前言1
1.1研究動機1
1.2國內外相關研究1
1.3研究目的與重要性2
第二章 研究背景5
2.1糖尿病6
2.2腦血管疾病8
2.3腦血流自動調控機制9
第三章 研究方法11
3.1前處理12
3.1.1 估測算法12
3.1.2 平均算法12
3.2時域分析14
3.2.1 平均值與標準差14
3.2.2交越相關分析15
3.2.3 相關係數分析15
3.2.4 腦血流自動調控曲線分析16
3.2.5 群化分析18
3.3頻域分析19
3.3.1 功率頻譜密度分析20
3.3.2 短時距傅立葉轉換分析21
3.3.3小波轉換分析23
3.3.3.1連續小波轉換23
3.3.3.2離散小波轉換23
3.3.3.3小波封包轉換30
3.3.3.4小波轉換之低頻與高頻比值31
第四章 系統架構32
4.1實驗對象33
4.2非侵入式生理檢查程序33
4.3系統架構35
第五章 實驗結果與討論38
5.1時域分析結果.39
5.1.1平均值與標準差結果41
5.1.2交越相關分析結果42
5.1.3腦血流自動調控曲線分析結果.44
5.1.4群化分析結果.47
5.2頻域分析結果.49
5.2.1功率頻譜密度分析49
5.3時-頻域分析結果52
5.3.1短時距傅立葉轉換分析.52
5.3.2小波轉換分析54
5.4討論57
第六章 結論與未來展望60
6.1結論60
6.2貢獻60
6.3未來展望61
參考文獻62
附錄一 程式界面66
附錄二 已發表之國內會議論文（一）72
附錄三 已發表之國內會議論文（二）73
附錄四 已發表之國內會議論文（三）74

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