以脈波抵達時間與間歇性校正推估連續血壓於姿勢性暈眩之研究

The Application of Pulse Arrival Time and Intermittent Calibration Method in Orthostatic Presyncope Symptoms

楊坤岳(Kun-Yueh Yang)

指導教授 ： 張恒雄

中原大學/工學院/醫學工程研究所/碩士(2006年)

https://doi.org/10.6840/CYCU.2006.00506

摘要

脊髓損傷病患於傾斜床訓練復健治療過程中，會產生姿勢性低血壓暈眩現象，血壓可能在短時間內會有急劇的變化。本研究將應用W. Chen提出之脈波抵達時間（Pulse Arrival Time, PAT）結合間歇性血壓校正推估連續血壓方法，觀察暈眩期間血壓變化，使用暈眩指數（Presyncope Symptoms, PS 1、2、3、4）的標準量化暈眩，評估暈眩對血壓的影響，期望於脊髓損傷病患產生姿勢性低血壓暈眩，提供暈眩發生的預測指標。
本研究於加護病房取得11位受測者，量取侵入式血壓等生理訊號，評估推估連續血壓方法可行性。為找出壓脈袋式與光體積描繪圖兩者脈波訊號之間的差異，因此量取14位正常受測者生理訊號，並比較其相關性。擷取9位脊髓損傷病患於傾斜床訓練（角度為0°、30°、45°、60°、75°）之生理訊號。以壓脈袋式脈波訊號進行暈眩期間連續血壓推估，與原先非侵入式血壓量測兩種方式，相互比較各暈眩程度之血壓參數值，觀察兩種方法之顯著差異，藉此得知暈眩程度影響血壓變化的關係。
研究結果顯示，進行W. Chen提出之連續血壓推估，與侵入式血壓相比有高度相關性，平均值為0.83。比較壓脈袋式與光體積描繪圖之脈波訊號進行連續血壓推估，具有高度相關性，平均值為0.88。使用非侵入式血壓判定暈眩期間血壓參數，於暈眩與不暈眩之間幾乎有顯著差異。而使用推估連續血壓方式估計，於暈眩時不同程度之間幾乎皆有顯著差異。
本研究結果證實推估連續血壓的確能夠有效辨別暈眩程度之間的差異，與非侵入式血壓相較已能提供暈眩上更好的鑑別能力。未來可應用此方法提供更多姿勢性低血壓暈眩生理回饋之血壓資訊，作為預測暈眩發生判斷的參考指標。

關鍵字

暈眩程度 ； 脈波抵達時間 ； 脈波 ； 非侵入式 ； 連續血壓

並列摘要

The blood pressure of spinal cord injury (SCI) patients with orthostatic syncope phenomenon was changed rapidly within short time during tilt table training and treating. In this research, the pulse arrival time (PAT) and intermittent calibration were estimated by continuous blood pressure (CBP) method of W. Chen, and observed the blood pressure changing during symptomatic. The levels of presyncope symptoms (PS) which included PS 1, 2, 3, and 4 were used to quantify the syncope levels, and evaluate.
In this research, 11 subjects who were in intensive care unit of hospital were used to acquire their physiological signals of invasive blood pressure, noninvasive blood pressure (NBP) etc., and to evaluate the feasibility of CBP method. In addition, 14 normal subjects were used to compare the pulse wave signal between photoplethysmography (PLETH) and cuff measurement.
Then the physiological signals were acquired during the tilt table training. The tilt angles were set at 0, 30, 45, 60 and 75 degree from 9 spinal cord injury patients with symptomatic and asymptomatic. The CBP from pulse wave signal of cuff measurement and NBP were calculated, and compared the levels of PS between CBP and NBP.
In result, the correlation coefficient between CBP and invasive blood pressure was 0.83., and the CBP method between PLETH and cuff measurement was 0.88. It was significant differences between symptomatic and asymptomatic in NBP method, and among the levels of PS in CBP method.
In conclusion, the estimated continuous blood pressure method could verify the discrimination of the levels of PS effectively, and provide the capability of identification of presyncope compared with NBP method.
In the future, the CBP method may provide more information of blood pressure for biofeedback control of orthostatic syncope and make the criterion of reference indicator of presyncope prediction in symptomatic situation.

並列關鍵字

Noninvasive ； Pulse Arrival Time ； Presyncope Symptoms ； Pulse Wave ； Continuous Blood Pressure

參考文獻

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