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研究生:吳經閔
研究生(外文):Jin-Ming Wu
論文名稱:外科腸胃道手術病患之遠距照護
論文名稱(外文):Telecare for Patients Undergoing Gastrointestinal Surgery
指導教授:賴飛羆賴飛羆引用關係
指導教授(外文):Feipei Lai
口試委員:林芳郁戴玉慈趙坤茂陳中平周迺寬莊仁輝
口試日期:2015-07-06
學位類別:博士
校院名稱:國立臺灣大學
系所名稱:生醫電子與資訊學研究所
學門:工程學門
學類:生醫工程學類
論文種類:學術論文
論文出版年:2015
畢業學年度:103
語文別:英文
論文頁數:75
中文關鍵詞:遠距照護腸胃道術後照護腸胃道手術營養治療通訊軟體應用程式
外文關鍵詞:Telecaregastrointestinal surgery caregastrointestinal surgerynutritional managementapplication
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本論文主要是研發遠距照護相關服務平台,提供外科腸胃道術後病患居家自我照顧,摘要說明如下:
腸胃道手術是治療腹部癌症最有效的方法。但是術後有些人容易產生併發症,例如: 老年人、多重慢性疾病和營養不良病患,當併發症發生時會造成住院天數延長、健保給付增加、或失能的情形。另一方面,台灣醫療面臨外科醫護人員短缺、健保支付制度改變及醫療資源分配不均等因素,造成病患和家屬無法安心出院居家療養。本研究結合台大醫院外科專業醫護團隊和台大醫院遠距照護中心,開發腸胃道術後遠距照護系統,其包含 (一): 導入腸胃道術後照護系統於台大醫院遠距照護中心, (二): 開發使用平板的遠距腸胃道術後照護系統,針對腸胃道術後病患的常見問題 (手術衛教、體重評估、腹內引流管追蹤和傷口感染),給予即時的居家照護幫助;選擇平板電腦應用在遠距照護的原因,在於使用介面較直覺,本身具有上網、照相及錄影功能,可以達到基本遠距照護系統需要的功能。
本論文評估遠距照護在外科腸胃道術後病患照顧的可行性和臨床價值,及研究加入遠距照護相較於傳統照護病患其術後營養狀態差異。


In this thesis, we develop a telecare system and tablet PC-based application services platform for patients undergoing gastrointestinal (GI) surgery. Telecare helps patients take care of themselves at home and have fast recovery.
The GI surgery is the most effective method for treating patients with abdominal cancers. However, patients of old age or with major comorbidities, or malnutrition had higher proportions of post-operative complications, which resulted in long hospital stays, more medical costs, and mortality. On the other hand, the current medical dilemma in Taiwan includes lack of surgical professionals, frequent change of national health insurance payment, and unbalanced medical resources. Therefore, the patients’ family have no enough confidence to take care of the patients at home. To solve this dilemma, we develop a telecare information system special for gastrointestinal surgery which including a tablet PC-based application to be used in National Taiwan University (NTUH) telecare center. This telecare information system provides a real-time service of follow-up of body weight, intra-abdominal drains, symptoms, surgery education, and surgical wound care. This study enrolled subjects undergoing GI surgery to investigate the clinical feasibility and value of telecare for surgical cases.


博士論文審定書 i
中文摘要 ii
Abstract iii
Contents v
List of Figures vii
List of Tables viii
Chapter 1 Introduction 1
1.1 Background of Gastrointestinal Surgery 1
1.2 Background of NTUH Telecare Center 3
1.3 Background of Gastrectomy for Gastric Cancer 4
1.4 Background of Heart Rate Variability on Obese Patients Undergoing Sleeve Gastrectomy 6
1.5 Aim of This Study 8
Chapter 2 Materials and Methods 9
2.1 System Architecture 9
2.1.1 Telecare at NTUH Telecare Center 9
2.1.2 Tablet PC-enabled Application 14
2.2 Heart Rate Variability 18
2.3 Computer-assisted Algorithm for Wound Assessment 20
2.3.1 Edge-based Image Processing 21
2.3.2 Color-based Image Processing 24
2.3.3 Color Normalization 25
2.3.4 Auto Threshold Adjustment 25
2.3.5 Wound Reconstruction 28
Chapter 3 Results 31
3.1 Implementation of Telecare for GI surgery Patients at NTUH Telecare Center 31
3.2 Tablet PC-enabled Application for Gastric Cancer Patients Undergoing Gastrectomy 33
3.2.1 Implementation of Interfaces 33
3.2.2 Web Service and Auto Notification Service 41
3.2.3 Assessment of Application Performance 42
3.3 Heart Rate Variability on Obese Patients Undergoing Sleeve Gastrectomy 47
3.4 Computer-assisted Algorithm for Wound Assessment 52
Chapter 4 Discussions 56
4.1 Implementation of Telecare for GI Surgery Patients at NTUH Telecare Center 56
4.2 Tablet PC-enabled Application for Gastric Cancer Patients Undergoing Gastrectomy 57
4.3 Heart Rate Variability on Obese Patients Undergoing Sleeve Gastrectomy 61
Chapter 5 Conclusion 66
References 67



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