臺灣博碩士論文加值系統

現今的呼吸治療過程中，呼吸治療師根據病患之臨床情況及通氣需求來設定呼吸器的控制模式、送氣波形與範型參數。屬於高風險醫療器材之呼吸器，以「使用方法不正確(不當設定、操作)」佔國內醫療器材風險原因中的第一位。對於一位藉由呼吸器維生的病人而言，身體的狀況隨時變化，固定的設定值並不一定適合病況，此外主觀經驗所造成的失誤也會相對的提高，而且人力成本也會居高不下。因此，發展一具智慧型控制器或具自我學習功能的控制器來控制人工呼吸器已是必然的趨勢。
本研究之目的即是針對現有之呼吸治療用呼吸器為特定對象，發展一個呼吸治療輔助用之模擬與控制機制，以PB7200呼吸器為設定模型，以持續命令式(Continuous Mandatory Ventilation, CMV)之強制換氣模式為主，並以一般醫院中常用之三種吸氣氣流型態為對象，包含正弦波、方波、漸減波三種波形，進行「定波形數學模式化」與「呼吸耗能最佳化」的研究。針對設定之病患呼吸機械特性與化學層面之通氣需求，利用最佳化的工具及所設計的最佳化模擬人機界面環境，以產生最佳化的通氣流速波形。
實驗結果針對呼吸治療病患之任何通氣反應變因改變，如二氧化碳吸入量、新陳代謝率、呼吸道阻抗及肺彈性等變化狀況，能迅速計算出CMV控制通氣設定參數(呼吸頻率、潮氣容積、尖峰氣流量)，同時可計算每分鐘肺通氣量、吸/吐氣時間比、動脈中二氧化碳偏壓等呼吸範型，並透過MATLAB®之GUI介面顯示最佳耗能結果波形。

In respiratory care process, the respiratory therapist generally utlize the control mode and apply parameters of the ventilator according to the clinical situation of patient. The ventilators have been categorized as the high risky medical apparatus, improper operations have been concluded as the primary reason for risks. The human factor has inevitably become main factor of risk in the respiratory care process. On the other hand, the health of patient may vary at any time while mechanical ventilation is applied. The established ventilation parameters might also not fit. Addition of fault may occur due to subjective experience, and hence it is urgent to develop an intelligent mechanical ventilator.
The purpose of this research is to develop simulation and controlling mechanism for ventilator as the supporting device of therapy. The PB7200 ventilator objected as the CMV mode is aimed. The research is carried for waveform modeling and optimization subject to sine, square, and descending waveforms.
The research is focused on the need of patient in mechanical characteristic and chemical aspect, utilize the optimization tool and simulation graphic user interface environments in order to produce optimal flow waveforms.
The experiments are performed based on changes in inhalation carbon dioxide, metabolism rate, airway impedance and lung elasticity, etc. Subject to changes in respiratory under CMV mode, the optimal waveforms can be obtained instantaneously through the MATLAB® Graphic User Interface.

誌謝 i
摘要 ii
Abstract iii
目錄 iv
圖目錄 vii
表目錄 x
第一章 緒論 1
1.1 前言 1
1.2 研究目的 2
1.3 相關文獻研討 4
第二章 呼吸治療與呼吸器 8
2.1 呼吸器發展暨肺部換氣作用 8
2.2 呼吸器驅動機構[70, 48, 41] 10
2.3 呼吸率及I/E比控制 14
2.4 呼吸器與呼吸臨床治療 15
2.5 呼吸器之控制模式與呼吸器吸氣波形 17
2.5.1壓力控制模式 18
2.5.2 流量控制模式 20
2.6 慢性阻塞性肺疾病 COPD與呼吸治療 23
2.7 急性呼吸窘迫症候群ARDS與呼吸治療 26
第三章 最佳控制呼吸系統模型 30
3.1 呼吸控制之數學模型 31
3.2 最佳機械－化學控制模式 32
3.2.1 受控體—氣體交換場所(肺臟) 33
3.2.2 回授路徑 33
3.2.3 最佳化性能指標控制器 34
3.2.4 神經—機械反應器(Neuro-Mechanical Effector) 35
3.3 肌神經驅動訊號之最佳化 36
3.4 送氣氣流波形之最佳化 38
3.4.1正弦波送氣氣流 40
3.4.2方波送氣氣流 42
3.4.3漸減波 43
第四章 實驗環境與最佳化模擬 46
4.1 呼吸器與呼吸生理 46
4.1.1 PB7200呼吸器通氣模式與吸氣波形設定簡介 46
4.1.2 人體呼吸通氣量簡介 48
4.2 呼吸模擬之模型與流程 50
4.3 模擬環境MATLAB®簡介 51
4.3.1 MATLAB Optimiztion ToolBox[72, 22] 53
4.3.2 MATLAB Graphic User Interface [72, 22] 56
第五章 呼吸器之最佳化送氣氣流波形模擬結果 57
5.1 最佳化波形模擬程序 57
5.2 呼吸生理模擬驗證 59
5.3 最佳化正弦波模擬 61
5.3.1 正弦波吸入二氧化碳響應 61
5.3.2 正弦波運動狀態響應 63
5.3.3 正弦波機械特性響應 63
5.4 最佳化方波模擬 65
5.4.1 方波吸入二氧化碳響應 65
5.4.2 方波運動狀態響應 65
5.4.3 方波機械特性響應 67
5.5 最佳化漸減波模擬 68
5.5.1 漸減波吸入二氧化碳響應 68
5.5.2 漸減波運動狀態響應 70
5.5.3 漸減波機械特性響應 70
第六章 結論與討論 73
6.1 正弦波、方波、漸減波吸入二氧化碳響應比較 73
6.2 正弦波、方波、漸減波運動狀態響應比較 74
6.3 正弦波、方波、漸減波機械特性響應比較 75
6.3.1 正弦波、方波、漸減波IRL 響應比較 76
6.3.2 正弦波、方波、漸減波ERL 響應比較 77
6.3.3 正弦波、方波、漸減波CRL 響應比較 77
6.3.4 正弦波、方波、漸減波CEL 響應比較 78
6.4 正弦波、方波、漸減波於吸入二氧化碳及運動狀態響應比較 79
6.5 結論 81
6.6 未來工作 82
參考文獻 84
附錄A 已在國內發表之論文 88

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