臺灣博碩士論文加值系統

高位脊髓損傷病患因自律神經傳導障礙，導致姿勢改變時，產生姿勢性低血壓，並併發眼花、暈眩的狀況。為研究對下肢加壓是否可幫助姿勢性低血壓患者改善暈眩狀況，本研究利用一套具控制系統之下肢加壓循環器，以可量化的生理參數量測為判斷基準，變更不同的氣壓幫浦壓力，將積存於患者下肢的血液壓回上肢，以延長患者的站立時間，並針對受試患者於不同傾斜床角度與不同氣壓幫浦壓力下之生理參數進行分析。經實驗結果證實，血壓會因傾斜床角度昇高而逐漸降低，也會因施加於下肢之幫浦壓力增加而昇高，下肢加壓循環器應用在治療因脊髓損傷所造成姿勢性低血壓之方面，的確可以有效的改善姿勢性低血壓。

One of the major complications in individuals with spinal cord injury (SCI) is orthostatic hypotension. Patients with SCI above T6 interrupt the sympathetic pathways from brain stem to sympathetic nerves and disrupt the voluntary muscle contractions of the lower extremities. Therefore, these patient may suffered from impairment of blood pressure control in the responses to postural change and severe venous pooling in the lower extremities. The purpose of our research is to try to use the Circulator Pumping System of Lower Extremities (CPSLE) to alleviate the orthostatic hypotension in subjects with SCI and to research the effect of changing the pumping pressure and the angle of tilt table in individuals with SCI.
The results showed this CPSLE could alleviate orthostatic hypotension in individuals with SCI. The blood pressure of patients decreases by the degree of tilt table increasing, and the blood pressure increases by the pumping pressure increasing.

致謝 ……………………………………………………………………一
摘要 ……………………………………………………………………三
Abstract ………………………………………………………………..四
目錄 ……………………………………………………………………五
圖目錄 …………………………………………………………………九
表目錄 ………………………………………………………………一五
第一章 緒論 ………………………………………………….……….1
1.1 研究動機 …………………………………………….………...1
1.2 研究目的 …………………………………………….………...2
1.3 論文架構 …………………………………………….………...2
第二章 文獻回顧 ………………………………………….……….4
2.1 脊髓神經作用 …………………………………….…………...4
2.2 脊髓損傷 ………………………………………….…………...6
2.3 自主神經與心臟血管循環 ……………………….…………...7
2.4 姿勢性低血壓 …………………………………….…………..10
2.5 治療姿勢性低血壓的方式 ……………………….…………..12
2.6 CPSLE於物理治療上的應用 ………………………………....15
第三章 研究方法與系統架構 ……………………………………..17
3.1 研究流程 ……………………………………………………...17
3.2 研究之應用對象 ……………………………………………...19
3.3 人體生理資料庫參數 ………………………………………...19
3.4 擠壓程序 ……………………………………………………...21
3.5 系統架構 ……………………………………………………...22
第四章 軟硬體連結與實驗方法 ………………………………....25
4.1 硬體連結 ……………………………………………………...25
4.1.1 傾斜床控制裝置 ……………………………....25
4.1.2 下肢加壓循環器 ……......................27
4.1.3 生理監視器 …………………………………....28
4.1.3.1 血壓量測計 ………………….....29
4.1.3.2 心電圖量測計 ……………….....31
4.1.3.3 SpO2量測器 ………………….....33
4.2 軟體工具 ……………………………………….............34
4.2.1 氣壓擠壓程序程式 ………………………......35
4.2.2 生理監視器程式 …………………………......38
4.2.3 心電訊號降頻與分析計算程式 …………......40
4.3 實驗方法 ……………………………………………….......42
4.4 實驗流程 ……………………………………………….......43
4.4.1 無氣壓幫浦加壓下肢之實驗 ………………....43
4.4.1.1 實驗前準備工作 …………….....44
4.4.1.2 實驗步驟 …………....45
4.4.1.3 實驗完成後之資料處理.46
4.4.2 不同氣壓幫浦加壓下肢之實驗 …………......46
4.4.2.1 實驗前準備工作 …………….....47
4.4.2.2 實驗步驟 ………......47
4.4.2.3 實驗完成後之資料處理 48
第五章 實驗結果 ………………………………………………....49
5.1 受試患者之資料 ………………………………....49
5.2 高位脊髓損傷受試者之實驗結果 ……………....50
5.2.1 C3受試患者實驗結果 ……….......50
5.2.2 C5受試患者實驗結果 ……….......59
5.2.3 T5受試患者實驗結果 ………….....66
5.3 非高位脊髓損傷受試者之實驗結果 …………....74
5.3.1 T11受試患者之實驗結果 ………....74
5.3.2 T12受試患者之實驗結果 ………....82
5.3.3 L2受試患者之實驗結果…………....89
5.4 討論 …………………………………………......97
5.4.1 實驗結果比較 ……………………...97
5.4.1.1血壓結果比較 ………...98
5.4.1.2心跳頻率結果比較 ....101
5.4.2 於不同傾斜床角度下幫浦壓力與血壓之研究 …......103
5.4.3 瘀痕現象…………………………...111
第六章 結論與建議 ……………………………………………...113
6.1 結論 ……………………………………………...113
6.2 未來發展之建議 ………………………………...114
參考文獻 ………………………………………………………....117
附錄一 ..…………………………………………………........125
附錄二 ………………………………………………………......129

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