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研究生:曹雅婷
研究生(外文):Ya-Ting Tsao
論文名稱:以心電圖參數對自律神經系統影響之探討
論文名稱(外文):Autonomic Nervous System (ANS) Biomarker Investigation Based on Electrocardiogram (ECG)
指導教授:沈祖望沈祖望引用關係
指導教授(外文):Tsu-Wang Shen
學位類別:碩士
校院名稱:慈濟大學
系所名稱:醫學資訊研究所
學門:醫藥衛生學門
學類:醫學技術及檢驗學類
論文種類:學術論文
畢業學年度:96
語文別:英文
論文頁數:85
中文關鍵詞:心率變異(HRV)PR變異(PRV)PR間距T-wave alternans (TWA)自律神經指標
外文關鍵詞:Heart Rate Variability (HRV)PR Variability (PRV)PR intervalT-wave Alternans (TWA)ANS biomarkers
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人體神經系統分為體神經系統和自律神經系統,而自律神經系統是不可由人體意識所控制的,是由身體自發性的調控與反應,自律神經系統之正常與否,會廣泛的影響身體機能,而許多病變會直接影響自律神經之調控,困難的是,自律神經很難由一般診斷觀察,因此很多學者都想找出具有代表性的自律神經系統的指標。然而自律神經系統(ANS)又區分為交感神經系統和副交感神經系統,分布於身體各器官上,心臟當然也不例外,其中的房室結與竇房結受交感與副交感神經支配,而調控心跳的快慢,此外像呼吸和血壓也都受自律神經影響亦可視為一種自主神經系統的指標。
因此,許多專家學者正在尋找心臟和自律神經系統間的關係,目前最廣泛用來觀察自律神經活動的指標是心率變異(HRV),本研究欲以心電圖為基礎找出除了心率變異外能反應自律神經系統活動的新生理指標;首先我們重複之前HRV相關研究來設計實驗,藉由姿勢改變來觀察自律神經系統之活動:我們的實驗首先由休息坐姿與後仰頭90∘之研究著手。進而設計第二個姿勢改變的實驗:利用站、坐、躺,來觀察自律神經系統。
在我們的研究中發現PR間距與T-wave alternans頻域分析等特徵會受自律神經系統影響。而且我們發現PR變異在頻域分析的表現較HRV為寬,因此我們對PR頻譜的頻帶作了新的定義。我們亦發現判斷致死型心臟病最常用的T-wave alternans ratio沒有辦法成功的區分姿勢變化,但實驗中卻發現了利用T波斜率的頻域分析能有效區分出姿勢的改變。因此本研究證實PR間距和TWA皆可能成為自律神經系統的新指標,此研究成果能更進一步可貢獻於心率調節器的演算法開發、輔助醫生診斷自律神經系統異常、改善心率變異分析及實現自律神經系統的仿生模擬。
Autonomic nervous system (ANS) is part of human’s nervous system which divided into the sympathetic and the parasympathetic nervous systems. The sinoatrial (SA) and atrioventricular (AV) nodes in the heart are also innervated by the sympathetic and parasympathetic. Besides, other biomarkers such as respiration and blood pressure can influence by ANS activities. Many experts investigated the relations between the heart and ANS. Most commonly, physicians nowadays use the heart rate variability (HRV) to observe ANS more than others.
Instead of previous HRV methods for investigate ANS; the aim of this research is to find possible additional ANS biomarkers also based on Electrocardiogram (ECG) for distinguishing the ANS activities. Our first experiment is to repeat pervious HRV research by changing ANS related poses, which are resting pose and 90° head-up tilt. And our second experiment plans to find out the different between supine, standing, and sitting. According to our research, it is obtained that the mean of PR interval and frequency analysis of T-wave alternans (TWA) are influenced by ANS activities. Moreover, our research found significant on discovery of frequency-domain of PR tachogram and makes a new definition on PRV spectrum. Although traditional TWA ratio has no significant relation with ANS activities, the spectrum analysis of slopes of T waves is a potential ANS biomarker. Hence, our experiment confirmed that both PR interval and frequency spectrum analysis of slope of T waves is a potential indicator of ANS. The observations can contribute knowledge on development of the pacemaker algorithm, doctor diagnosis, HRV analysis, and ANS physiological modelling.
Acknowledgement
Abstract
Contents
Figure Contents
Table Contents
1. Introduction
2. Methodology
2.1. Data Acquisition and Experiment Setup
2.2. Signal Process - P, Q, R, S, and T Fiducial Point Detection
2.3. Heart Rate Variability (HRV) Analysis
2.4. PR Variability (PRV) Analysis
2.4.1 PR Interval Extraction and Basic Analysis
2.4.2 Bandwidth Evaluation - Short-term Fourier Transform (STFT)
2.4.3 Determination of PRV Frequency Bands
2.4.4 Comparison on ANS Stabilized Time of Mean of RR Intervals and PR Intervals
2.4.5 Correlation Analysis among Different Fiducial Point Intervals
2.4.6 Artificial Neural Networks (ANN) for ANS Activity Classification
2.5. T Wave Alternans (TWA) Analysis
2.5.1 T Wave Extraction
2.5.2 Traditional T-wave Alternans Analysis
2.5.3 Our Proposed Enhanced Spectral Method for ANS Investigation
2.5.4 Our Proposed Spectral Analysis of T-Slope Variations (TSV) for ANS Investigation
3. Results
4. Conclusions
5. Discussions
6. Future works
References
Appendix A – Linear Regression Relations Figures
Appendix B – T-Test Results of different features
Appendix C – The Analysis Results of Voting System
Appendix D – Previous Works
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