臺灣博碩士論文加值系統

在美國每年約有3500個案例與睡眠有關的死亡，包括嬰兒猝死症候群、意外窒息和不明原因造成的死亡，而這些死亡原因與呼吸系統有著密切關係。故本論文發展一套非侵入式嬰兒睡眠呼吸監測系統，並開發主動式安全裝置用於避免嬰兒趴睡窒息。本研究使用氣墊式壓力感測來偵測呼吸的變化，當嬰兒躺於感測墊上時，即可量測嬰兒呼吸過程中的胸部微弱振動，並將訊號分類為三種不同的模式，為呼吸模式、活動模式及異常模式。為了驗證本系統提供之生理參數是否具有臨床價值，在實驗中量測10位年齡為7.7±2.249月大的嬰兒睡眠呼吸訊號，並同時使用標準量測儀器進行量測。藉由二元混淆矩陣驗證本系統活動模式辨別能力，並藉由相關性分析兩系統呼吸訊號R-R間隔與每分鐘呼吸次數，結果顯示本系統活動模式的平均敏感度為0.9835，平均陽性預測值為0.9402，呼吸模式的平均敏度為0.9844，平均陽性預測值為0.9926，可見本系統在活動模式判別上有相當高的正確性。兩系統在R-R時間間隔與每分鐘呼吸次數其相關係數(r)分別為0.896與0.976，呈現良好的一致性。另外本研究開發可模擬各種呼吸模式之擬真嬰兒，用於模擬呼吸中止的發生以驗證本系統的模式判別與警報反應時間，經由10次的測試後，得到平均反應時間為20.36±1.0177秒鐘，並觸發主動安全裝置，經觸發後立即啟動幫浦，使8公斤重擬真嬰兒在11秒內離開床墊，並在9秒後將氣囊充氣至0.4 kg/cm^2產生空氣層高度為2.8cm，提供嬰兒足夠的空氣，亦給予嬰兒更安全的照護環境，在照護者到達前做最立即的處理。

There are about 3,500 sleep-related deaths among U.S. babies each year, including sudden infant death syndrome (SIDS), accidental suffocation, and deaths from unknown causes, and these causes of death are strictly related to the respiratory system. Therefore, this paper develops a non-invasive baby sleep-breathing monitoring system with an active safety device to prevent baby’s suffocating. When a baby is lying on the air cushion with a pressure sensor, the baby's weak vibrations of respiratory in the chest can be detected, and then the breathing signal is classified into three different modes, namely breathing mode, active mode, and abnormal mode. In an experimental test, the subjects are ten infants with an age of 7.7±2.249 months. We measure the breathing signal, synchronously from our system, and the standard measuring instrument. The confusion matrix is used to verify the ability of the system to identify the activity mode. For RR interval of the respiratory signal and the number of breaths per minute calculated from two systems, we can obtain the correlation with each other. The results show that the average sensitivity and the average positive predictive value of the identification are 0.9835 and 0.9402, respectively. The average sensitivity and the average positive predictive value of the breathing pattern are 0.9844 and 0.9926, respectively. The results show the high correlation of the identification of activity pattern. The correlation coefficient (r) between each other for the R-R interval and the number of breaths per minute are 0.896 and 0.976, respectively. Besides, this study designed an imitation baby that can simulate various breathing mode. It is used to simulate the occurrence of respiratory arrest to verify the mode discrimination and alarm reaction time of the system. After ten tests, the average reaction time was 20.36±1.0177 seconds. And for testing the active safety device, the device turn-on the pump immediately after the trigger, so that the 8 kg simulated baby leaves the mattress within 11 seconds, and after 9 seconds, the airbag inflated to 0.4 kg/cm2 pressure. The airbags lift the breathable cloth 2.8 cm high to generate the air camber and to provide enough air for the baby. This device provides the most immediate treatment before the caregiver arrives.

摘要 i
Abstract ii
致謝 iii
目錄 iv
表目錄 vi
圖目錄 vii
第一章 緒論 1
1.1研究背景與文獻探討 1
1.1.1嬰兒死亡原因 1
1.1.2監測設備 5
1.1.3呼吸特徵與呼吸狀態分類 12
1.2研究動機與目的 14
1.3論文架構 15
第二章 材料與方法 16
2.1系統架構流程 16
2.2感測墊設計 17
2.3呼吸訊號量測電路 19
2.3.1高靈敏壓力感測器 19
2.3.2濾波電路 20
2.3.3可程式調控放大增益 22
2.3.4類比數位轉換器(ADC) 23
2.4數位訊號處理 24
2.4.1 IIR數位濾波器 24
2.4.2波峰檢測法 & IPA & IPI 25
2.5識別活動模式 28
2.6增益倍率調整與微增壓微洩壓 30
2.7每分鐘呼吸率 31
2.8擬真嬰兒製作 32
2.9主動式安全裝置 34
2.9.1氣囊規格與數據 35
2.10電腦顯示介面 39
第三章 實驗設計 40
3.1標準參考工具 40
3.1.1波峰檢測法 41
3.2實驗設計 43
3.3實驗架構 44
3.4資料分析與驗證 45
第四章 結果 48
4.1無察覺式感測墊呼吸監測系統 48
4.2使用擬真嬰兒測試系統 52
4.2.1第一種情境-系統功能測試 52
4.2.2第二種情境-擬真嬰兒正常呼吸測試 55
4.2.3第三種情境-擬真嬰兒呼吸異常測試 58
4.3真實嬰兒系統測試 59
4.3.1活動模式正確性 59
4.3.2 R-R時間間隔相關性 64
4.3.3每分鐘呼吸次數相關性 67
4.4主動安全裝置測試 70
第五章 討論 71
第六章 結論 73
參考文獻 74

[1]The United Nations Children's Fund (UNICEF), Under-five mortality, March 2018.
[2]World Health Organization(WHO), Child mortality levels: Number of deaths (thousands), 2018.
[3]The United Nations Children's Fund (UNICEF), Neonatal mortality: The neonatal period is the most vulnerable time for a child, March 2018.
[4]Centers for Disease Control and Prevention (CDC), Causes of Infant Mortality, 2017.
[5]W. Callaghan, M. MacDorman, S. Rasmussen, et al., “The Contribution of Preterm Birth to Infant Mortality Rates in the United States,”Pediatrics, vol. 118, no. 4, pp. 1566-1573, May 2006.
[6]L. Gutierrez, L. Arenas, S. Huerta, et al., “Recommendations to improve healthcare of neonates with respiratory insufficiency beneficiaries of Seguro Popular,” Salud Publica Mex, vol. 54, no. 1, pp. 57–64, 2012.
[7] J. Ersch, M. Kleiner, P. Baeckert, et al., “ Increasing incidence of respiratory distress in neonates,” Acta Paediatr, vol. 96, no. 11, pp. 1577–1581, 2007.
[8]World Health Organization(WHO), Global Health Observatory data: Child health, 2018.
[9]M. Willinger, L. James, C. Catz,“Defining The Sudden Infant Death Syndrome (SIDS): Deliberations of an Expert Panel Convened by the National Institute of Child Health and Human Development,” Fetal and Pediatric Pathology, vol. 11, pp. 677-684, Mar 1991.
[10]Duncan JR, Byard RW,“SIDS Sudden Infant and Early Childhood Death: The Past, the Present and the Future,” Adelaide (AU): University of Adelaide Press, May 2018.
[11]Roger W. Byard,“Sudden Death in the Young,” Cambridge University Press, January 2013.
[12]Rachel Y Moon, Rosemary S C Horne, Fern R Hauck, “Sudden infant death syndrome,” The Lancet, vol. 370, no. 9598, pp. 1578-1587, 2007.
[13]Centers for Disease Cntrol and Prevention, Vital Signs: Trends and Disparities in Infant Safe Sleep Practices — United States, 2009–2015, January 2018.
[14]A. Erck Lambert, S. Parks, C. Cottengim, et al., “Sleep-Related Infant Suffocation Deaths Attributable to Soft Bedding, Overlay and Wedging,” Pediatrics, vol. 143, no. 5, 2019.
[15]Parmelee AH, Stern E, “Development of states in infants. In: Clemente CD, Purpura DP, Mayer FE, editors. Sleep and the maturing nervous system.” New York: Academic Press. pp. 199–228, 1972.
[16]M. Ednick, A. Cohen, G. McPhail, et al.,“A Review of the Effects of Sleep During the First Year of Life on Cognitive, Psychomotor, and Temperament Development,” National Center for Biotechnology Information, vol. 32, no. 11, pp. 1449-1458, Nov 2009.
[17]National Sleep Foundation, How Much Sleep Do Babies and Kids Need?
[18]W. Blystad,“ Blood Gas Determinations on Premature Infants III. Investigations on Premature Infants with Recurrent Attacks of Apnea,” Acta Paediatrica, vol. 45, pp. 211-221, May 1956.
[19]Miller HC, Behrle FC, Smull NW,“ Severe apnea and irregular respiratory rhythms among premature infants; a clinical and laboratory study,” Pediatrics, vol. 23, no. 4, Apr 1959.
[20]P. Perlstein, N. Edwards, J. Sutherland,“ Apnea in premature infants and incubator-air-temperature changes,” New England Journal of Medicine, vol. 282, no. 9, pp. 461-466, Feb 1970.
[21]Medscape, Pediatric Apnea , Sep 2018.
[22]Cochrane Library, Continuous distending pressure for respiratory distress in preterm infants, July 2015.
[23]Cochrane Library, Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome, October 2007.
[24]S. Pullano, I. Mahbub, M. Bianco, et al., “Medical Devices for Pediatric Apnea Monitoring and Therapy: Past and New Trends,” IEEE Reviews In Biomedical Engineering, vol. 10, pp. 199-212, Sep 2017.
[25]Y. Brans, and W. Hay, “Physiological Monitoring and Instrument Diagnosis in Perinatal and Neonatal Medicine, Cambridge,” U.K.: Cambridge Univ. Press, 1995.
[26]F. Kritzinger, S. Al-Saleh, I. Narang, “Descriptive Analysis of Central Sleep Apnea in Childhood at a Single Center,” Pediatric Pulmonology, vol. 46, no. 10, pp. 1023-1030, April 2011.
[27]E. Katz, R. Mitchell, C. D'Ambrosio, “Obstructive Sleep Apnea in Infants Eliot,” American Journal of Respiratory and Critical Care Medicine, vol. 185, no. 8, pp. 805-816, Apr 2012.
[28]Hongbin Li, Wentong Ge, Jun Tai, Jie Zhang, Xiaoyi Wang, Zhuo Li, Xin Ni, Jingying Ye, “Duration criterion of respiratory events for children with obstructive sleep apnea,” Int. J. Pediatric Otorhinolaryngol., vol. 79, no. 12, pp. 2364–2367, 2015.
[29]S. Konstantinopoulou, and I. E. Tapia, “Neurocognitive and behavioural outcomes following intervention for obstructive sleep apnoea syndrome in children,” Paediatric Respiratory Rev, vol. 20, pp. 51–54, 2016.
[30]R. Bhattacharjee, L. Kheirandish-Gozal, G. Pillar, and D. Gozal, “Cardiovascular complications of obstructive sleep apnea syndrome: Evidence from children,” Prog. Cardiovascular Diseases, vol. 51, no. 5, pp. 416– 433, 2009.
[31]C. Cook, J. Sutherland, S. Segal, et al.,“Studies of Respiratory Physiology in the Newborn Infant. III. Measurements of Mechanics of Respiration,” The Journal of clinical investigation, vol. 36, no. 3, pp. 440-448, Mar 1957.
[32]S. Fleming, M. Thompson, S. Scientist,“Normal ranges of heart rate and respiratory rate in children from birth to 18 years: a systematic review of observational studies,” The Lancet, vol. 377, no. 9770, pp. 1011-1018, Mar 2011.
[33]A. Fekr, M. Janidarmian, K. Radecka, et al., ”Respiration Disorders Classification With Informative Features for m-Health Applications,” Biomedical and Health Informatics IEEE Journal of, vol. 20, no. 3, pp. 733-747, 2016.
[34]C. Kushida, M. Littner, T. Morgenthaler, et al., “Practice Parameters for the Indications for Polysomnography and Related Procedures: An Update for 2005,” American Acadwmy of Sleep Medicine, vol. 28, no. 4, pp. 499-523, 2017.
[35]Sleep And Respiratory Disorders, What is a Sleep Disorder Test ? April 2014.
[36]A. Gupta, ” Respiration Rate Measurement Based on Impedance Pneumography,” Texas Instruments Application report SBAA181, pp. 1-11, February 2011.
[37]M. Neuman, D. Fleming, T. Baird, et al., ”Monitoring Infant Respiration Using an Eight­Channel Transthoracic Impedance Monitor,” Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, vol. 6, pp. 2516-2517, 1992.
[38]I. Sadek, E. Seet, J. Biswas, et al., ” Nonintrusive Vital Signs Monitoring for Sleep Apnea Patients: A Preliminary Study,” IEEE Access, vol. 6, pp. 2506-2514, December 2017.
[39]R. Johnston,K. Nakano, K. Fujita, et al., “A non-contact high resolution piezoelectric film based sensor for monitoring breathing during sleep,” Proceeding of the 3rd international conference of global network for innovative technology 2016 (3rd ignite-2016): Advanced Materials for Innovative Technologies, July 2017.
[40]T. Ishikawa, H. Ando, K. Kobayashi, et al., “A Study on Sleep Stage Estimation via Non-invasive Air Mattress Sensor,” SICE Annual Conference in Fukui, pp. 4-7, 2003.
[41]W. Lin, R. Zhang, J. Brittelli, et al., “Wireless Infant Monitoring Device for the prevention of sudden infant death syndrome,” 2014 11th International Conference and Expo on Emerging Technologies for a Smarter World, CEWIT 2014, pp. 1–4, 2014.
[42]M. Ednick, A. Cohen, G. McPhail, et al.,“ Real-Time Non-Contact Infant Respiratory Monitoring Using UWB Radar,” 2015 IEEE 16th International Conference on Communication Technology (ICCT), pp. 493-496, Feb 2016.
[43]楊雯婷, “視覺式嬰兒呼吸監測系統,” 國立臺灣師範大學資訊工程所碩士論文, 6月 2015.
[44]F. Luo, J. Liu, N. Ma, et al., ” A fiber optic microbend sensor for distributed sensing application in the structural strain monitoring,” Elsevier, vol. 75, no. 1, pp. 41-44, May 1999.
[45]N. Lagakos, J. Cole, J. Bucaro, ” Microbend fiber-optic sensor,” Applied Optics, vol. 26, no. 11, pp. 2171, 1987.
[46]R.Medlock, “Fibre optics in process-control,” Control Instrum,vol. 21, no. 4, pp. 105–108, 1989.
[47]V. Demjanenko, R. A. Valtin, M. Soumekh, et al., “A noninvasive diagnostic instrument for power circuit breakers,” IEEE Transactions on Power Delivery, vol. 7, no. 2, pp. 656–663, 1992.
[48]V. Fook, K. Leong, E. JianZhong, et al., “Non-Intrusive Respiratory Monitoring System using Fiber Bragg Grating Sensor,” 2008 10th IEEE Intl. Conf. on e-Health Networking, Applications and Service, Healthcom 2008, pp. 160–164, 2008.
[49]D. Lau, Z. Chen, J. Teo, et al., “Intensity-Modulated Microbend Fiber Optic Sensor for Respiratory Monitoring and Gating During MRI,” IEEE Transactions on Biomedical Engineering, vol. 60, no. 9, pp. 2655–2662, 2013.
[50]J. De Jonckheere, F. Narbonneau, M. Jeanne, et al., “OFSETH: Smart medical textile for continuous monitoring of respiratory motions under magnetic resonance imaging,” Proceedings of the 31st Annual International Conference of the IEEE Engineering in Medicine and Biology Society: Engineering the Future of Biomedicine, EMBC 2009, pp. 1473–1476, 2009.
[51]Y. García, J. Corres, J. Goicoechea, “Vibration Detection Using Optical Fiber Sensors,” Hindawi Publishing Corporation, vol. 2010, pp. 10–17, 2010.
[52]A. Misaki, K. Imanishi, S. Takasugi, et al., “Body Pressure Sensing Mattress for Bedsore Prevention,” SEI Technical Review, no. 78, pp. 95–99, 2014.
[53]M. Enayati, M. Skubic, M. James, et al., “Sleep Posture Classification Using Bed Sensor Data and Neural Networks,” 40th International Engineering in Medicine and Biology Conference, 2018.
[54]M. Holtzman, S. Member, D. Townsend, et al., “Breathing Sensor Selection During Movement,” 33rd Annual International Conference of the IEEE EMBS Boston, pp. 381-384, 2011.
[55]N. Bu, N. Ueno, O. Fukuda, “Monitoring of Respiration and Heartbeat during Sleep using a Flexible Piezoelectric Film Sensor and Empirical Mode Decomposition,” Annual International Conference of the IEEE Engineering in Medicine and Biology – Proceedings, pp. 1362-1366, 2007.
[56]Y. Nijsure, W. Tay, E. Gunawan, et al., “An Impulse Radio Ultrawideband System for Contactless Noninvasive Respiratory Monitoring,” IEEE Transactions on Biomedical Engineering, vol. 60, no. 6, pp. 1509-1517, 2013.
[57]D. Zito, D. Pepe, “Monitoring respiratory pattern in adult and infant via contactless detection of thorax and abdomen movements through SoC UWB pulse radar sensor,” BioWireleSS 2014 - Proceedings: 2014 IEEE Topical Conference on Biomedical Wireless Technologies, Networks, and Sensing Systems, 2014.
[58]Caniou J, “ Passive infrared detection: theory and applications,” 1999.
[59]J. Fei, I. Pavlidis,“ Virtual Thermistor,”Annual International Conference of the IEEE Engineering in Medicine and Biology - Proceedings, pp. 250-253, 2007.
[60]S. Leonhardt,K. Heimann, T. Orlikowsky, et al., ”Neonatal non-contact respiratory monitoring based on real-time infrared thermography,” BioMedical Engineering OnLine, pp. 1-17, 2011.
[61]J. Pan, W.Tompkins, ”A real-time QRS detection algorithm,” IEEE Transactions on Biomedical Engineering, vol. BME-32, no. 3,pp. 230-236, Mar 1985.
[62]G. Friesen, T. Jannett, M. Jadallah, et al., ”A Comparison of the Noise Sensitivity of Nine QRS Detection Algorithms,” IEEE Transactions on Biomedical Engineering, vol. 37, no. 1, pp. 85-98, 1990.
[63]P. Du, A. Warren, Simon M. Lin, ”Improved peak detection in mass spectrum by incorporating continuous wavelet transform-based pattern matching,” Bioinformatics, vol. 22, no. 17, pp. 2059-2065, Sep 2006.
[64]G. Vijaya, Vinod Kumar, H. K. Verma, ”ANN-based QRS-complex analysis of ECG,” Journal of Medical Engineering & Technology, vol. 22, no. 4, pp. 160-167, Jul 2009.
[65]P. Várady, T. Micsik, S. Benedek, et al., ”A novel method for the detection of apnea and hypopnea events in respiration signals,” IEEE Transactions on Biomedical Engineering, vol.49, no. 9, pp. 936-942, Sep 2002.
[66]B. Koley, D. Dey, ” Automatic detection of sleep apnea and hypopnea events from single channel measurement of respiration signal employing ensemble binary SVM classifier,” Measurement: Journal of the International Measurement Confederation, vol. 46, no. 7, pp. 2082-2092, 2013.
[67]Freescale Semiconductor, MPXV4006 Series Integrated Pressure Sensor datasheet, 2009.
[68]S. Davis, P. Watkinson, A. Guazzi, et al., ”Continuous non-contact vital sign monitoring in neonatal intensive care unit,” Healthcare Technology Letters, vol. 1, no. 3, pp. 87-91, July 2014.
[69]W. Lu, M. Nystrom, P. Parikh, et al., ”A semi-automatic method for peak and valley detection in free-breathing respiratory waveforms,”Medical Physics, vol. 33, no. 10, pp. 3634-3636, July 2006.