臺灣博碩士論文加值系統

『脊側神經阻斷術』，為麻醉醫學上使用的麻醉術。目前臨床上的使用方式為，以體外B-MODE超音波探頭監測穿刺過程，穿刺針傾斜穿刺進入皮下肋間神經處，注入局部麻醉劑，阻斷神經的疼痛。統計指出，氣胸發生率為0.5%。因現有的方式準確性不高，具有危險性。
本研究使用高頻超音波正向探針作為正向穿刺導引。超音波是利用物質介面聲阻抗差異，提供介面回波，肌肉的聲阻抗為1.71MRal，肺的聲阻抗為0.18MRal，因為差距很大，可以接收反射訊號。本研究中高頻超音波探針，壓電晶體為PMN-PT，探頭中心頻率約為20MHz，探頭對齊穿刺針尖的位置。穿刺路徑改成垂直穿刺，從針尖所收的A-MODE訊號重組成M-MODE圖，並且清楚看到肺部隨著呼吸前後移動，同時使用64Channel的體外超音波探頭觀測。同時也開發體外的8MHz超音波探頭，先以Field 2進行聲場模擬計算出訊號最強的位置來決定尺寸，透過A-mode訊號可以從體外判斷出肺部在皮下的位置，達到縮小體積的目的。在施打麻醉穿刺針時，從體外顯示影像確認，並且注射3毫升的水來判定針尖位置是否到達空腔，發現空腔體積脹大，證實實驗是可行的。

『Paravertebral nerve block』are commonly used in the clinical anesthsia . Physian observe the path of insertion with ultrasound probe, and the needle is inserted in-plane to the space between the transverse process and pleura. Local anesthetic then is injected to block the nerve transmission temporarily. The incidence of the pleura punctured is around 0.5%. In this study, we developed a high frequency ultrasound needle to guide the needle insertion. We can receive ultrasound echo signal because of the significant difference of the acoustic impedance of the muscle and the lung. We use the piezoelectric crystal PMN-PT as the material of the ultrasound transducer, and the center frequency of the crystal is 20MHz. The position of transducer aligns with the puncture needle, and the path of insertion changes to be inserted vertically. Then, we transform the A-MODE signal from the transducer needle to M-MODE image, and we can observe the signal of lung is moving forward and backward when the respirator inhaling and exhaling. We also observe the intercostal space and the paravertebral space by the 64-channel ultrasound probe. When we injected 3ml water into the space, the image of 64-channel ultrasound probe shows the space is larger, so we can confirm that the needle is really inserted into the space. We also developed the low frequency ultrasound transducer, which is made of PZT, and the center frequency is 8MHz. We simulate the acoustic field of ultrasound transducer by Field 2, and we can calculated the size of ultrasound transducer to achieve the strongest signal. Then we can observe the depth of the lung by the A-MODE signal from the low frequency ultrasound transducer. The purpose of this study is using the high frequency ultrasound needle and combining the A-MODE low frequency transducer to position the intercostal and the paravertebral space. By reducing the volume of B-MODE ultrasound transducer , it is more convenient for doctors than before.

目錄
摘要 i
ABSTRACT ii
目錄 iv
圖目錄 v
表目錄 vi
第一章 簡介 1
第二章 實驗材料與研究方法 3
2.1 ULTRASOUND THEORY 3
2.2 ULTRASOUND PROBE SIMULATION 3
2.3 ULTRASOUND PROBE MANUFACTURE 6
2.4 IMPEDANCE MATCHING NETWORK 10
2.5 量測系統架設 12
第三章 實驗方法與材料 13
第四章 實驗結果與討論 17
第五章 結論與未來研究 22
參考文獻 24


圖目錄
圖 1 5MM×5MM，8MHZ探頭的LINE PROFILE。 4
圖 2 5MM×5MM，8MHZ探頭的平面聲場強度分布圖。 5
圖 3探針結構 8
圖 4探針成品圖 8
圖 5探頭結構圖 9
圖 6探頭成品圖 10
圖 7阻抗匹配方式 11
圖 8阻抗匹配電路及探針 11
圖 9量測探針的系統架設 12
圖 10探針測試，鋼塊回波訊號於2.7MM處 13
圖 11探針阻抗分析圖 14
圖 12左圖為20MHZ探針匹配前的回波訊號，頻寬為5MHZ，右圖則為匹配後的回波訊號，頻寬提升至13MHZ。 14
圖 13探頭之回波訊號，距離4MM，約1.4V。 15
圖 14 探頭回波訊號的FFT圖，頻寬約為3MHZ。 15
圖 15探頭之阻抗分析圖。 16
圖 16脊側神經阻斷術施打位置。 17
圖 17 目前手術施行方式。 18
圖 18顯示距離訊號距離激發訊號1MM與1.5MM處為內肋間肌肉的訊號，該訊號也會隨著呼吸器而前後移動。 18
圖 19進行動物實驗穿刺方式 19
圖 20 脊側神經阻斷術的體外超音波B-MODE圖。 19
圖 21打水前後比較圖。 20
圖 22左邊為脊側神經阻斷術M-MODE重組訊號圖，右邊則為對應的A-MODE訊號圖。 20


表目錄
表 1探針製作的物件參數 6
表 2發射接收機(PR5900)的發射參數 12

參考文獻
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