臺灣博碩士論文加值系統

神經外科加護病房中，醫師們在對病患預後做預測時，大多憑靠他們個人的臨床經驗，雖然可做出相當程度之預測，但仍有一些較難判斷的案例。因此，本研究則以模糊理論，將許多專業醫師多年來的臨床經驗，歸納成模糊規則，而以這些規則架構的模糊模型，使用者只需將指定的參數輸入，即可得到所需的輸出(患者預後狀況)。
本論文吸取文獻的研究經驗，探討影響患者腦傷預後之因素，並依據現有的環境與設備，發展出生醫訊號擷取系統以連續監測及記錄病患之血壓與顱內壓等生理訊號。接著，以此系統針對頭部外傷之病患進行訊號的擷取收集，之後再輔以相關性分析及模糊理論，並綜合臺大醫院神經外科加護病房醫師們的臨床知識，進而對病患做出預測性的預後評估，並將此評估定為FOS(Fuzzy Outcome Scale)。
此研究不僅能在醫師的臨床判斷上提供一客觀的評估方法，醫師也可藉由系統的評估，調整適合每個病人的治療方式，對病情達到最佳的控制。

When neurosurgeons predict the prognosis of neurocritical ill patients with severe head injuries, mostly by their personal clinical experiences, though can make the prediction analogous to the degree, but there are some cases more difficult to judge. For this reason, we set up a fuzzy model with fuzzy logic theory and clinical experiences of neurosurgeons. The user can get the state of patient's prognosis only needs to input some designated parameters.
This thesis is probing into those factors of patient's prognosis by research, and build a system to continuous monitor and write down physiological signals of patients, like BP(blood pressure) and ICP(intracranical pressure) etc., according to existing environments and equipments. Moreover, the data capture by this system is mainly aimed at patients with severe head injuries. Afterward, it predicts the prognosis with fuzzy logic theory, Pearson product-moment correlation coefficient, and clinical experiences of neurosurgeons. In the end, we define the predictive prognosis as FOS(Fuzzy Outcome Scale)。
The contribution of this study is offer neurosurgeons an objective assessment method in the clinical judge and neurosurgeons can change treatment way which suitable each patient's with the assessment of the system to reach the best control to the condition.

目 錄
封面 i
書名頁 ii
授權書 iii
國科會授權書 iv
博碩士論文電子檔案上網授權書 v
論文指導教授推薦函 vi
論文口試委員會審定書 vii
中文摘要 viii
誌謝 x
目 錄 xi
表目錄 xiii
圖目錄 xiv
第一章 緒論 1
1-1 研究背景 1
1-2 文獻回顧 2
1-3 研究目的 3
1-4 章節簡介 3
第二章 腦傷預後影響因素 5
2-1 自我調節機轉介紹 5
2-2 自我調節機轉影響因素 6
2-2-1 Glasgow昏迷評分（Glasgow Coma Scale, GCS）介紹 6
2-2-2 顱內壓與腦灌流壓 7
2-2-2-1 顱內壓(ICP) 8
2-2-2-2 腦灌流壓(CPP) 9
2-2-3 年齡(AGE) 11
2-2-4 動脈血壓(ABP)與顱內壓(ICP)兩者間的相關係數(PRx) 11
2-3 術後療效評定 12
2-4 本章結論 13
第三章 模糊理論 14
3-1 模糊系統之概念介紹 14
3-2 模糊理論在病人昏迷狀態模擬之應用 16
3-2-1 定義輸入及輸出變數 16
3-2-2 定義各語言變數的資料庫 16
3-2-3 建立模糊規則庫 21
3-2-4 決定模糊推論機構 22
3-2-5 解模糊化以得到真實輸出 26
3-3 本章結論 29
第四章 實驗環境及方法 30
4-1 實驗對象 30
4-2 實驗環境介紹 31
4-2-1 生理訊號監視器 31
4-3 系統介紹 33
4-3-1 訊號擷取系統 33
4-3-2 模糊模型 40
4-4 實驗步驟 40
4-5 實驗方法 41
4-6 實驗注意事項 41
4-7 本章結論 41
第五章 臨床數據分析 42
5-1 模糊模型之輸入 42
5-1-1 輸入變數求得方法 42
5-2 模糊模型之輸出 45
5-2-1 輸出變數求得方法 45
5-3 數據分析 45
5-4 本章結論 51
第六章 未來展望 52
6-1 總結 52
6-2 未來展望 52
參考文獻 54

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