臺灣博碩士論文加值系統

本研究目的為測試運用腦室外引流系統裝置與大氣壓力相通方式下測量顱內壓的準確性與再測信度，並探討不同的腦脊髓液比重是否影響此顱內壓測量方法的準確性。研究對象為62位裝置有腦室外引流系統之病患。測量方法係利用腦室外引流系統裝置與監測器二種測量工具，以隨機分配方式先後測量個案平躺、15度及30度三種床頭高度之顱內壓，每一種高度做6次。二種測量工具所測得之顱內壓平均值以皮爾森積差相關、配對t檢定及Bland-Altman分析法，比較二種測量工具之一致性與準確性，結果以Bland-Altman分析圖呈現。腦室外引流系統裝置測量顱內壓之再測信度則以皮爾森積差相關及變異係數做分析。
結果顯示二種測量方式所得之平均測量值在床頭高度0度時，有顯著相關（r =.93, p < .001），平均差異值（bias）及標準差為2.0 ±1.6 mmHg，平均差異值具統計顯著差異（p < .001），一致性界限（bias ± 2SD）從 - 1.2到5.2 mmHg。在床頭抬高15度時亦有顯著相關（r = .94, p < .001），平均差異值及標準差為2.1 ± 1.5 mmHg，平均差異值有統計顯著差異（p < .001），一致性界限從 - 0.9到5.2 mmHg。床頭高度30度時也是有顯著相關（r = .95, p < .001），平均差異及標準差為2.0 ± 1.6 mmHg，平均差異值有統計顯著差異（p < .001），一致性界限從 - 1.2到4.9 mmHg。而腦脊髓液比重對腦室外引流系統與監測器測量之平均值差異的影響，結果顯示無統計顯著相關（P > .05）。
再測信度方面，6次測量值之間均呈顯著相關（p < .001），具有良好再測信度，然而由變異係數比較結果發現，在平躺時CV =3.69%，15度時CV = 6.62%，30度時CV = 7.88%，有床頭高度越高，測量變異越大，穩定度越差之情形。
綜合以上結果發現，腦室外引流系統與監測器測量值之間缺乏一致性，而腦脊髓液比重並不影響此一致性不佳的結果，因此腦室外引流系統裝置與監測器二種顱內壓測量工具不可互相取代，在使用腦室外引流系統做顱內壓測量時，建議以再測信度佳、測量變異最少的平躺姿勢做測量。
關鍵字：腦室外引流系統、顱內壓測量、準確性、再測信度

The purpose of this study was to examine the accuracy and reproducibility of intracranial pressure (ICP) measured by the external ventricular drainage (EVD) system. The effect of specific gravity (SpGr) of cerebral spinal fluid (CSF) on the accuracy of the EVD-measured-ICP was also determined. Sixty-two subjects with EVD system were included. The ventriculostomy catheter connected to both the ICP monitor and EVD system was used to measure ICP. ICP was repeatedly measured 6 times in three positions: head at 0 degree, head up 15 degree and head up 30 degree. The accuracy of the EVD-measured-ICP was determined using the Pearson’s correlation, paired t-test, and Bland-Altman method. Analysis of the reproducibility of ICP measurements by EVD system was done with the Pearson’s correlation and coefficient of variation (CV).
The mean of ICP between two measurements was significantly correlated (r = .93, p < .001) at head 0 degree position, and the bias (mean difference) showed significant differences (p < .001), the standard deviation was 2.0 ± 1.6 mmHg, and the limit of agreement (bias ± 2SD) were between - 1.2 and 5.2 mmHg. Position at head up 15 degree displayed significant correlation (r = .94, p < .001), the bias showed significant differences
(p < .001), and the standard deviation was 2.1 ± 1.5 mmHg, with the limits of agreement being - 0.9 and 5.2 mmHg. At head up 30 degree, the correlation between measurements was significant (r = .95, p < .001), the bias had significant difference (p < .001), the standard deviation was 2.0 ± 1.6 mmHg, and the limits of agreement were - 1.2 and 4.9 mmHg. There was no significant correlation between SpGr of CSF and difference of mean ICP by EVD system and monitor measurements (p > .05).
The EVD-measured-ICP had good reproducibility (p < .001). But the CV at head 0 degree was 3.69%, head up 15 degree was 6.62%, and head up 30 degree was 7.88%. The CV became worse as the head elevated.
In conclusion, the agreement of ICP measurements between the EVD system and monitor was poor, and the SpGr of CSF did not affect this result. Therefore, the EVD system cannot replace the monitor for ICP measurement. The results suggested good measurement at supine position when ICP was measured by the EVD system.
Key words: External ventricular drainage system, Intracranial pressure measurement, Accuracy, Reproducibility

目錄
頁數
致謝……………………………………………………………………… Ⅰ
中文摘要………………………………………………………………… Ⅲ
英文摘要………………………………………………………………… Ⅴ
目錄……………………………………………………………………… Ⅶ
圖表目次………………………………………………………………… Ⅹ
第一章 緒論
第一節 研究動機…………………………………………… 1
第二節 研究提案…………………………………………… 4
第二章 文獻查證
第一節 腦脊髓液與顱內壓………………………………… 5
第二節 顱內壓測量………………………………………… 6
第三節 腦室外引流………………………………………… 13
第四節 影響顱內壓測量之相關因素 ─ 以腦室外引流系
統為例……………………………………………… 14
第三章 研究方法
第一節 研究場所與對象…………………………………… 18
第二節 研究工具…………………………………………… 18
第三節 收集資料過程……………………………………… 20
第四節 資料分析方法……………………………………… 22
第四章 結果分析
第一節 個案基本特性……………………………………… 24
第二節 二種測量值一致性分析…………………………… 27
第三節 顱內壓對二種測量值一致性的影響……………… 36
第四節 呼氣末期陽壓使用與否對二種測量值一致性的影
響…………………………………………………… 42
第五節 昏迷嚴重程度對二種測量值一致性的影響……… 58
第六節 腦脊髓液比重與二種測量方式測量值差異之相關性評估以及對二測量值一致性的影響……….………... 59
第七節 腦室外引流系統測量顱內壓之再測信度與穩定度
評估……………………………………………….... 63
第五章 討論
第一節 二種測量工具的一致性…………………………… 67
第二節 腦脊髓液比重對測量一致性的影響……………… 69
第三節 腦室外引流系統測量工具之再測信度…………… 70
第六章 結論與建議
第一節 結論………………………………………………… 71
第二節 研究限制…………………………………………… 71
第三節 建議………………………………………………… 72
參考資料
中文部份……………………………………………………… 74
英文部份……………………………………………………… 75
























圖表目次
頁數
圖一 床頭高度0度，腦室外引流系統與監測器顱內壓測量平均
值之散佈圖……………………………………………………… 29
圖二 床頭高度0度，腦室外引流系統與監測器顱內壓測量平均
值之Bland-Altman分析圖……………………………………... 30
圖三 床頭高度15度，腦室外引流系統與監測器顱內壓測量平
均值之散佈圖…………………………………………………… 31
圖四 床頭高度15度，腦室外引流系統與監測器顱內壓測量平
均值之Bland-Altman分析圖…………………………………... 32
圖五 床頭高度30度，腦室外引流系統與監測器顱內壓測量平
均值之散佈圖…………………………………………………… 33
圖六 床頭高度30度，腦室外引流系統與監測器顱內壓測量平
均值之Bland-Altman分析圖…………………………………... 34
圖七 床頭高度0度，高顱內壓組之腦室外引流系統與監測器顱
內壓測量平均值之散佈圖……………………………………… 38
圖八 床頭高度0度，高顱內壓組之腦室外引流系統與監測器顱
內壓測量平均值之Bland-Altman分析圖……………………... 39
圖九 床頭高度0度，低顱內壓組之腦室外引流系統與監測器
顱內壓測量平均值之散佈圖……………………………….... 40
圖十 床頭高度0度，低顱內壓組之腦室外引流系統與監測器
顱內壓測量平均值之Bland-Altman分析圖………………... 41
圖十一 床頭高度0度，使用呼吸器合併呼氣末期陽壓輔助治療
之腦室外引流系統與監測器顱內壓測量平均值之散佈圖… 45
圖十二 床頭高度0度，使用呼吸器合併呼氣末期陽壓輔助治療
之腦室外引流系統與監測器顱內壓測量平均值之
Bland-Altman分析圖………………………………………… 46
圖十三 床頭高度15度，使用呼吸器合併呼氣末期陽壓輔助治療
之腦室外引流系統與監測器顱內壓測量平均值之散佈圖… 47
圖十四 床頭高度15度，使用呼吸器合併呼氣末期陽壓輔助治療
之腦室外引流系統與監測器顱內壓測量平均值之
Bland-Altman分析圖………………………………………… 48
圖十五 床頭高度30度，使用呼吸器合併呼氣末期陽壓輔助治療
之腦室外引流系統與監測器顱內壓測量平均值之散佈圖… 49
圖十六 床頭高度30度，使用呼吸器合併呼氣末期陽壓輔助
治療之腦室外引流系統與監測器顱內壓測量平均值之
Bland-Altman分析圖……………………………………….. 50
圖十七 床頭高度0度，未使用呼吸器合併呼氣末期陽壓輔助
治療之腦室外引流系統與監測器顱內壓測量平均值之
散佈圖……………………………………………………….. 51
圖十八 床頭高度0度，未使用呼吸器合併呼氣末期陽壓輔助
治療之腦室外引流系統與監測器顱內壓測量平均值之
Bland-Altman分析圖……………………………………….. 52
圖十九 床頭高度15度，未使用呼吸器合併呼氣末期陽壓輔助
治療之腦室外引流系統與監測器顱內壓測量平均值之
散佈圖……………………………………………………….. 53
圖二十 床頭高度15度，未使用呼吸器合併呼氣末期陽壓輔助
治療之腦室外引流系統與監測器顱內壓測量平均值之Bland-Altman分析圖……………………………………….. 54
圖二十一 床頭高度30度，未使用呼吸器合併呼氣末期陽壓輔助
治療之腦室外引流系統與監測器顱內壓測量平均值之
散佈圖……………………………………………………….. 55
圖二十二 床頭高度30度，未使用呼吸器合併呼氣末期陽壓輔助
治療之腦室外引流系統與監測器顱內壓測量平均值之Bland-Altman分析圖……………………………………….. 56
表一 個案基本特性……………………………………………….. 25
表二 三種床頭高度之二種顱內壓測量值平均差異值分析…….. 35
表三 依呼氣末期陽壓使用與否分組，在三種床頭高度下測
得之二種顱內壓測量值平均差異值分析………………….. 57
表四 依腦脊髓液比重分組，在三種床頭高度下測得之二種
顱內壓測量值平均差異值分析…………………………….. 62
表五 床頭高度0度時，腦室外引流系統測量顱內壓之再測
信度相關係數矩陣………………………………………….. 64
表六 床頭高度15度時，腦室外引流系統測量顱內壓之再測
信度相關係數矩陣………………………………………….. 65
表七 床頭高度30度時，腦室外引流系統測量顱內壓之再測
信度相關係數矩陣………………………………………….. 66

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