臺灣博碩士論文加值系統

心血管疾病近年來成為人類的主要死因之一，其中冠狀動脈心臟病為心血管疾病中常見的好發類型。心導管手術因侵入性低且恢復期短，常用於治療心血管疾病，為介入性手術的一種，透過導絲及導管的操作，將血管支架置入冠狀動脈中的病灶處釋放，並利用支架的徑向支撐力使阻塞的血管恢復暢通。
心導管手術中，為了讓醫生操作時能夠精確的控制導絲在血管中的位置和行進方向，避免對血管壁造成損傷，需於病人體內注射顯影劑，並於手術室內使用輻射造影，以即時觀察導絲於血管內的位置。即便醫生可穿著鉛衣，降低身體接收到的輻射劑量，然而長期暴露於輻射環境，仍會對身體造成不可逆的負面影響。
為解決醫生長期處於輻射環境的問題，本研究將針對心導管手術中，推送和旋轉導絲的動作，開發一套手術自動化之設備，使醫生可於手術室外進行手術，免除輻射劑量的疑慮。此設備之機構分為醫生端及病人端兩組，醫生於手術室外操控醫生端機台，而病人端機台接收到醫生端的數據後，將推送或旋轉導絲的運動行為即時同步實行於病人，達到遠端操控的目的。為提高追蹤表現，本系統使用PID控制器搭配模糊控制器，降低追蹤誤差，大幅提高系統即時性與準確性的表現。
為使醫生於操作此自動化設備時，可即時得知導絲於血管內的阻力，以免誤傷血管，此設備包含力回饋之設計，將病人端機構將量測獲得的導絲阻力數值同步實現於醫生端，使醫生操作時感受到真實的阻力變化，大幅降低手術風險。
系統控制的部分，本研究使用C#對兩端的控制元件進行整合，並開發圖形化人機介面，供醫生於手術時觀測輻射造影的畫面與導絲即時位置的相關數據，此外，本研究設計了多樣實驗，校正系統中各環節的誤差，最後以模擬血管驗證此手術自動化設備的可行性。

In recent years, cardiovascular disease has become one of the main causes of death in humans. Also, coronary heart disease is a common type of cardiovascular disease. Cardiac catheterization surgery is often used to treat cardiovascular diseases due to its low invasiveness and short recovery period. In addition, it is a type of interventional surgery. Through the operation of guide wires and catheters, the vascular stent is placed into the coronary artery lesion and released. The radial force of stent restores the blocked blood vessels back to normal.
In cardiac catheterization surgery, in order to allow surgeons to accurately control the position and travel direction of the guide wire in the blood vessel to avoid damage to the vascular wall, it is necessary to inject contrast dye into the blood vessel and use radiography in the operating room to observe the position of the guide wire immediately. Even if the surgeon can wear a lead coat to reduce the radiation dose received by the body, long-term exposure to the radiation environment will still cause irreversible negative effects on the body.
To solve the problem that surgeons have to be exposed to the radiation environment for a long time, this study will develop a set of surgical automation device for the operation of pushing and rotating the guide wire during cardiac catheterization. Therefore, the surgeon can perform surgery outside the operating room, eliminating the doubt of radiation dose. The mechanism of this device is divided into two sides: the surgeon-side and the patient-side. The surgeon controls the surgeon-side device outside the operating room. After the patient-side device receives the data from the surgeon-side, the movement behavior of pushing or rotating the guide wire is synchronously implemented on the patient in realtime, accomplishing the purpose of remote manipulation. In order to improve the tracking performance, the system uses PID controller and fuzzy controller in combination to reduce tracking errors and substantially improve the performance of immediacy and accuracy.
In order to allow surgeons to know the resistance of the guide wire in the blood vessel instantly when operating this automation device, so as not to accidentally damage the blood vessel, this device includes a force feedback design, which synchronizes the value of the guide wire resistance measured by the patient-side mechanism with the surgeon-side counterpart. Consequently, the surgeon can feel resistance changes during operation, which greatly reduces the risk of surgery.
For the system control part, this study uses C# to integrate the components at both sides, and develops a graphical user interface for surgeons to observe the radiography images and the data of the real-time position of the guide wire during surgery. In addition, this study designed some experiments to correct errors in the automated system. Finally, this study verified the feasibility of this surgical automation device with simulated blood vessels.

口試委員審定書 i
誌謝 ii
摘要 iii
Abstract iv
目錄 vi
圖目錄 ix
表目錄 xiii
第一章　緒論 1
1.1. 心血管疾病 1
1.2. 心導管手術 3
1.3. 研究目的 6
1.4. 研究內容與本文架構 7
第二章　文獻回顧 9
第三章　醫生端 12
3.1. 操作步驟 12
3.2. 使用元件 14
3.3. 機構設計 19
3.3.1. 推送導絲 19
3.3.2. 旋轉導絲 20
3.3.3. 力回饋實現 21
3.4. 控制系統 22
第四章　病人端 23
4.1. 使用元件 23
4.2. 機構設計 30
4.2.1. 設計概念 30
4.2.2. 運作流程 33
4.3. 控制系統 36
第五章 系統整合 38
5.1. 系統運作架構 38
5.2. 圖形化使用者介面 39
5.3. PID控制器 40
5.3.1. 理論 40
5.3.2. 應用—推送導絲 41
5.3.3. 應用—旋轉導絲 44
5.4. 模糊控制器 46
5.4.1. 理論 46
5.4.2. 應用 47
第六章　實驗分析與結果討論 52
6.1. 阻力量測實驗 52
6.1.1. 實驗設計 52
6.1.2. 實驗結果與討論 53
6.2. 力回饋實現實驗 55
6.2.1. 實驗設計 55
6.2.2. 實驗結果與討論 56
6.3. 輸送準確度實驗 57
6.3.1. 實驗設計 57
6.3.2. 實驗結果與討論 57
6.4. 手術操作模擬 59
6.4.1. 實驗設計 59
6.4.2. 實驗結果與討論 61
第七章　結論與未來展望 62
參考文獻 64

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