臺灣博碩士論文加值系統

當病人罹患肺部疾病例如「急性呼吸窘迫症」時，肺容積下降是導致他們呼吸困難的主要原因。在臨床方面，經常使用胸廓局部變化來診斷肺功能，因胸廓能反映出局部的肺容積狀態。本研究目的在於開發一套可以即時監測胸廓局部變化的裝置，提供醫療人員觀察患者肺容積連續變化的狀態，此裝置是應用多個彎曲感測器製作成綁帶，以便放置於病患的胸廓，當病患呼吸時，此系統會收到從微處理器傳來的電阻變化所轉換成之角度資訊，再將角度資訊應用B-Spline方法重建胸廓曲線。測試實驗分為靜態與動態實驗；在靜態實驗方面，將綁帶放置於已知形狀之物體外圍，以評估其準確性及再現性。在動態實驗方面，則將三條綁帶放置於一位男性受測者胸廓上，同步使用流量計量測呼吸流量，參考Konno與Mead等人所提出演算法，利用從監測裝置得到的截面積變化與流量計得到的體積變化找出最佳的體積測量關係係數。從實驗結果顯示，在靜態分析中本研究所開發之裝置可達90%準確性，其標準差最高僅為3%；在動態實驗中，重建出的曲線確實會隨著呼吸變化。總結，本研究提出一種可基於體積校準並可評估胸廓局部變化的監測裝置。

When patients having respiratory related diseases such as acute respiratory distress syndrome (ARDS), lung volume decrease is the major cause for dyspnea. In clinics, the regional chest wall motion is often used for the diagnosis of lung function because it reflects the regional lung volume changes. The purpose of this study is to develop a real-time device for monitoring chest wall motion using the flex sensors, so as to provide the medical personnel a device to observe the continuous changes of lung volume. Multiple sensors are integrated into a belt for placing on the chest and abdominal wall. During the respiration, the proposed system may receive the angle information derived from the impedance change, which is sent from the microprocessor. All the angle information will then be used for reconstructing the contour of chest wall using B-Spline method. In this study, two experiments including the static and dynamic measurements are performed for system evaluation. In static experiment, sensing belt is placed on several known shapes of plates for accuracy and repeatability analysis. In dynamic experiment, three sensing belts are firstly attached on a male subject chest wall. Then, a pneumotachometer is employed for simultaneously measuring the respiratory flow. An algorithm proposed by Konno and Mead is modified for obtaining the best correlation coefficients that relates the cross section change to volume change. From the experimental results, the static measurements show that the accuracy is about 90% with the standard deviation within 3%. In dynamic measurements, the proposed device is demonstrated to be feasible for continuously displaying the chest wall changes during respiration. In summary, this study develops a volume calibration based device for monitoring the regional motion of chest wall.

中文摘要 I
ABSTRACT III
CONTENTS V
List of Figures VII
List of Table IX
Chapter 1 Introduction 1
1.1 Respiration 1
1.1.1 Respiratory system 1
1.1.2 Chest Wall Mechanics 3
1.2 Clinical Measure Methods 4
1.2.1 Mobile X-ray Machine 4
1.2.2 Respiratory Inductive Plethysmography 4
1.2.3 Optoelectronic Plethysmography 6
1.2.4 Image-based Method 7
1.3 Flex Sensor 8
1.4 Motivations and Purposes 9
Chapter 2 Methods and Materials 10
2.1 Architecture Overview 10
2.2 Hardware Design 11
2.2.1 Microcontroller 11
2.2.2 Flex Sensor and Setup Position 12
2.2.3 Multiplexer 13
2.2.4 Wheatstone Bridge Circuit and Single-Supply Amplifier 14
2.3 Software Design 15
2.3.1 System Control Program 15
2.3.2 Measurement Method 16
2.3.3 Graphic Program 18
2.3.4 B-Spline 19
2.3.5 Physiological Parameters 21
2.4 Experimental Design 22
2.4.1 Static Analysis 22
2.4.2 Dynamic Analysis 25
Chapter 3 Results 27
3.1 System Implementation 27
3.2 Sensors’ Characteristics 29
3.3 Software Graphic 31
3.4 Static Experiment 31
3.5 Human Experiment 33
3.5.1 Flow Signal Processing 33
3.5.2 Signal Processing 34
3.5.3 Combining Two Signals 35
3.5.4 Signal Calibration 36
3.5.5 Searching the Optimum Coefficients and Reconstructing the Volume Variation 37
3.5.6 Synchronous Analysis 38
Chapter 4 Discussion 40
4.1 Characteristics of Sensors 40
4.2 Experiment 41
Chapter 5 Conclusion and Prospects 42
5.1 Conclusions 42
5.2 Prospects 43
References 44

[1] Wilhelm, Mallat, Human Anatomy, 7th ed. U.S.A.: Pearson, 2013.
[2] A. A. Weaver, S. L. Schoell, and J. D. Stitzel, “Morphometric analysis of variation in the ribs with age and sex, J Anat, vol. 225, no. 2, pp. 246–261, Aug. 2014.
[3] G. J. Quinlan and T. W. Evans, “Acute respiratory distress syndrome in adults., Hosp Med, vol. 61, no. 8, pp. 561–563, Aug. 2000.
[4] L. B. Ware and M. A. Matthay, “The acute respiratory distress syndrome, N. Engl. J. Med., vol. 342, no. 18, pp. 1334–1349, May 2000.
[5] “Lung Recruitment in Patients with the Acute Respiratory Distress Syndrome — NEJM.[Online].Available: http://www.nejm.org.
[6] M. Zompatori, F. Ciccarese, and L. Fasano, “Overview of current lung imaging in acute respiratory distress syndrome, European Respiratory Review, vol. 23, no. 134, pp. 519–530, Dec. 2014.
[7] H.-K. Wang, T.-W. Lu, R.-J. Liing, T. T.-F. Shih, S.-C. Chen, and K.-H. Lin, “Relationship Between Chest Wall Motion and Diaphragmatic Excursion in Healthy Adults in Supine Position, Journal of the Formosan Medical Association, vol. 108, no. 7, pp. 577–586, Jul. 2009.
[8] “Chest Wall Mechanics in ARDS | SpringerLink. [Online]. Available: https://link.springer.com.
[9] “ATS/ESICM/SCCM Guidelines on Management of ARDS in Adults, Speciality Medical Dialogues, 03-Apr-2018. [Online]. Available: https://speciality.medicaldialogues.in
[10] A. Aliverti, R. Dellacà, P. Pelosi, D. Chiumello, L. Gattinoni, and A. Pedotti, “Compartmental Analysis of Breathing in the Supine and Prone Positions by Optoelectronic Plethysmography, Annals of Biomedical Engineering, vol. 29, no. 1, pp. 60–70.
[11] R. H. Warren, S. M. Horan, and P. K. Robertson, “Chest wall motion in preterm infants using respiratory inductive plethysmography, European Respiratory Journal, vol. 10, no. 10, pp. 2295–2300, Oct. 1997.
[12] R. Sartene, P. Martinot-Lagarde, M. Mathieu, A. Vincent, M. Goldman, and G. Durand, “Respiratory cross-sectional area-flux measurements of the human chest wall, Journal of Applied Physiology, vol. 68, no. 4, pp. 1605–1614, Apr. 1990.
[13] K. Konno and J. Mead, “Measurement of the separate volume changes of rib cage and abdomen during breathing, J Appl Physiol, vol. 22, no. 3, pp. 407–422, Mar. 1967.
[14] A. Aliverti, R. Dellacà, P. Pelosi, D. Chiumello, L. Gattinoni, and A. Pedotti, “Compartmental Analysis of Breathing in the Supine and Prone Positions by Optoelectronic Plethysmography, Annals of Biomedical Engineering, vol. 29, no. 1, pp. 60–70.
[15] A. De Groote, M. Wantier, G. Cheron, M. Estenne, and M. Paiva, “Chest wall motion during tidal breathing, Journal of Applied Physiology, vol. 83, no. 5, pp. 1531–1537, Nov. 1997.
[16] C. M. A. Reinaux et al., “Tidal volume measurements in infants: Opto-electronic plethysmography versus pneumotachograph, Pediatr. Pulmonol., vol. 51, no. 8, pp. 850–857, Aug. 2016.
[17] A. Lodovico, P. Cerveri, G. Ferrigno, and R. M. L. Barros, “A novel video-based method using projected light to measure trunk volumes during respiration, Computer Methods in Biomechanics and Biomedical Engineering, vol. 14, no. 8, pp. 707–713, Aug. 2011.
[18] G. Elshafie, P. Kumar, S. Motamedi-Fakhr, R. Iles, R. C. Wilson, and B. Naidu, “Measuring changes in chest wall motion after lung resection using structured light plethysmography: a feasibility study, Interact Cardiovasc Thorac Surg, vol. 23, no. 4, pp. 544–547, Oct. 2016.
[19] J. M. Harte et al., “Chest wall motion analysis in healthy volunteers and adults with cystic fibrosis using a novel Kinect-based motion tracking system, Med Biol Eng Comput, pp. 1–10, Feb. 2016.
[20] T. Yamada et al., “A stretchable carbon nanotube strain sensor for human-motion detection, Nat Nano, vol. 6, no. 5, pp. 296–301, May 2011.
[21] “NUCLEO-L053R8 - STM32 Nucleo-64 development board with STM32L053R8 MCU, supports Arduino and ST morpho connectivity - STMicroelectronics. [Online]. Available: http://www.st.com.
[22] Sparkfun Electronic, “Flex Sensor 4.5 SEN-08606 Datasheet. [Online]. Available: http://www.spectraymbol.com.
[23] Analog Devices, “ADG731 Analog Multiplexers User Guide. Analog Devices, 2015.
[24] “INA118 Precision, Low Power Instrumentation Amplifier | TI.com. [Online]. Available: http://www.ti.com/product/INA118.
[25] “B-splines. [Online]. Available: https://www.cl.cam.ac.uk.
[26] “《DarkBlack》: B-spline curve, 《DarkBlack》. [Online]. Available: https://darkblack01.blogspot.com