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研究生(外文):Hsin-Yen He
論文名稱(外文):Entropy Analysis of Blood Flow Sound in Vascular Access in Hemodialysis Patients and Its Application
指導教授(外文):Jia-Jung Wang
外文關鍵詞:HemodialysisArteriovenous fistulaArtificial fistulaBlood flow soundFistula stenosisApproximate entropySample entropyMultiscale entropy
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本論文中所測量之病人共119例,皆由高雄榮民總醫院心臟血管中心就診案例中篩選,利用已開發之裝置分別擷取透析瘻管動脈癒合端、瘻管中點及靜脈癒合端等三個位置約三十秒之血流聲音訊號,並分別利用近似熵、樣本熵及多尺度熵方法進行分析,以便觀察洗腎患者在進行血管擴張手術前後血流聲音熵值的差異。在近似熵分析結果顯示,手術後動脈癒合端(0.3359±0.3309 vs 0.2642±0.2673)及瘻管中央位置(0.2861±0.3267 vs 0.2291±0.2693)所測得血流聲音的熵值均顯著大於手術前(p<0.05);相似地,手術後動脈癒合端(0.3936±0.4961 vs 0.2627±0.3675)及瘻管中央位置(0.3601±0.5099 vs 0.2642±0.3678)所測得血流聲音的近似熵熵值也顯著大於手術前(p<0.05)。
As the number of patients with chronic diseases such as obesity, diabetes, high blood pressure and the elderly population are increasing, the number of people with kidney disease is also elevated. In addition, improper medication habits have made such disease more serious and accelerated. Since more people receive hemodialysis treatment due to severe kidney disease resulting from diabetes and high blood pressure, more incidences of hemodialysis access dysfunction occur. In either an arteriovenous fistula or an artificial fistula, stenosis or obstruction may take place after a period of use. Therefore, the purpose of this thesis was to measure the phonoangiogram (PAG) signals of the vascular access and to analyze them by using the approximate entropy, sample entropy, and multiscale entropy methods, respectively.
The study included 119 patients receiving hemodialysis. All of them were screened from the Cardiac Vascular Center of Kaohsiung Veterans General Hospital. Individual ten-second PAG signals originated from the healing end of the artery, the midpoint of the fistula and the healing end of the vein were measured by the developed device. In the approximate entropy analysis, entropy values of the PAG signals from the healing end of the artery (0.3359±0.3309 vs. 0.2642±0.2673) and from the midpoint of the fistula (0.2861±0.3267 vs. 0.2291±0.2693) were significantly larger after surgery than before surgery (p<0.05).
Similarly, in the sample entropy analysis, we found that entropy values of the PAG signals from the healing end of the artery (0.3936±0.4961 vs. 0.2627±0.3675) and from the midpoint of the fistula (0.3601±0.5099 vs. 0.2642±0.3678) were significantly greater after surgery, as compared with those before surgery (p<0.05).
In conclusion, the approximate, sample and multiscale entropy methods may be applied for identifying whether there is any stenosis phenomenon in the vascular access. This will be helpful in the detection of early stenosis in vascular access, and then subsequent medical treatment will probably prolong the usage life of the hemodialysis fistula.
致謝 I
摘要 II
Abstract IV
目錄 VI
圖目錄 VIII
表目錄 IX
第一章、緒論 1
1-1、前言 1
1-2、相關文獻探討 4
1-3、研究動機與目的 6
第二章、血流聲音擷取裝置系統 7
2-1、透析瘻管血流聲音擷取裝置 7
2-2、擷取系統各組成裝置 9
2-2-1、電容式麥克風聽診器 9
2-2-2、血流聲音擷取裝置 10
2-2-3、血管血流聲音輸出裝置 11
2-2-4、心跳波形記錄裝置 12
2-2-5、生理訊號擷取裝置 13
2-2-6、資料分析軟體 14
第三章、瘻管血流聲音分析方法及實驗設計 15
3-1、血流聲音擷取方法 15
3-2、血流聲音擷取實驗設計 17
3-3、分析方法 19
3-3-1、訊號處理方法 19
3-3-2、近似熵 Approximate Entropy 22
3-3-3、樣本熵 Sample Entropy 23
3-3-4、多尺度熵 Multiscale entropy 24
3-4、統計分析 25
第四章、數據分析與統計結果 26
4-1、受測者基本資料 26
4-2、量測結果 27
4-3、近似熵分析結果 31
4-4、樣本熵分析結果 32
4-5、多尺度熵分析結果 34
4-6、多尺度熵雙因子變異數分析結果 39
第五章、討論 45
5-1、血流聲音量測系統之探討 45
5-2、受測者實驗設計之探討 46
5-3、實驗數據分析之探討 47
第六章、結論及未來展望 48
6-1、結論 48
6-2、未來展望 49
參考文獻 50
[1] Available:Moor Instrument https://www.azuravascularcare.com/medical-services/dialysis-access-management/av-fistula-creation/ https://www.azuravascularcare.com/medical-services/dialysis-access-management/av-graft-placement/
[2] Available:Moor Instrument http://www.chimei.org.tw/main/cmh_department/53000/nurse_epaper/nurse10409/menu1_4.html
[3] Available:Moor Instrument https://www.tsn.org.tw/UI/L/TWRD/ebook_2017%E5%B9%B4%E5%A0%B1.pdf (2017台灣腎病年報)
[4] Rabiner L.R., Schafer R.W., Digital Processing of speech Recognition Signal,Prentice Hall(1978).
[5] Mansy H. A., Hoxie S. J., Patel N. H., Sandler R.H., “Computerised analysis of auscultatory sounds associated with vascular patency of haemodialysis access,” Med Biol Eng Comput,43(1):56-62,2005.
[6] Kian K., Asif A., “Status of research in vascular access for dialysis,” Nephrol Dial Transplant, 25(11):3682-6, 2010.
[7] Lomonte C., Casucci F., Antonelli M., Giammaria B., Losurdo N., Marchio G., Basile C., “Is there a place for duplex screening of the brachial artery in the maturation of arteriovenous fistulas?,” Semin Dial, 18(3):243-6, 2005.
[8] Surlan M., Popovic P., “The role of interventional radiology in management of patients with end-stage renal disease,”Eur J Radiol, 46(2):96-114, 2003.
[9] Gibson K.D., Stehman-Breen C.O., Kohler T.R., “Use of vascular diagnostic laboratory in improving the success of angioaccess procedures,” Semin Vasc Surg, 14(3):222-6, 2001.
[10] Depner T.A., Krivitski N.M., MacGibbon D., “Hemodialysis access recirculation measured by ultrasound dilution,” ASAIO J, 41(3):M749-53, 1995.
[11] Vasquez P., Marco M.M., Mattsson E., Mandersson B., “Application of the Empirical Mode Decomposition in the study of murmurs from Arteriovenous fistula stenosis,” Conf Proc IEEE Eng Med Biol Soc, 2010:947-50, 2010.
[12] Mansy H.A., Hoxie S.J., Patel N.H., Sandler R.H., “Computerised analysis of auscultatory sounds associated with vascular patency of haemodialysis access,” Med Biol Eng Comput, 43(1):56-62, 2005.
[13] Campos R.P., Chula D.C., Perreto S., Riella M.C., Nascimento M. M., “Accuracy of stenosis in hemodialysis arteriovenous fistula,” Semin Dial, 21(3): 269-73, 2008.
[14] Trerotola S.O., Ponce P., Stavropoulos S.W., Clark T.W., Tuite C.M., Mondschein J.I., Shlansky-Goldberg R., Freiman D.B., Patel A.A., Soulen M.C., Cohen R., Wasserstein A., Chittams J.L., “Physical examination versus normalized pressure ratio for predicting outcomes of hemodialysis access interventions,” J Vasc Interv Radiol, 14(11): 1387-94, 2003.
[15] 長期血液透析瘻管失能的處置賴奇正 ; 葉同成 ; 林俊堯 ; 許智揚 ;蕭世宏 ; 馬光遠 ; 劉俊鵬 內科學誌 19:3 2008.06[民 97.06] 頁197-204
[16] 血液透析瘻管評估新趨勢 萬芳醫院 洗腎室 秦庭瑩 護理師 報告時間 2006年11月23日
[17] Munguia M.M., Vasquez P., Mattsson E., and Mandersson B., “Acoustical detection of venous stenosis in hemodialysis patients using principal component analysis,” Conf Proc IEEE Eng Med Biol Soc, 2010:3654-7, 2010.
[18] Pincus S.M., Approximate entropy as a measure of system complexity, Proc. Natl. Acad. Sci. U. S. A. 1991;88: 2297–2301.
[19] Richman J.S., Moorman J.R., Physiological time-series analysis using approximate entropy and sample entropy. Am J Physiol Heart Circ Physiol. 2000; 278: H2039–H2049.
[20] A Humeau-Heurtier., The Multiscale Entropy Algorithm and Its Variants: A Review.entropy.2015; 17, 3110-3123.
[21] Applying Contemporary Statistical Techniques 2003, Pages 329-360
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