行動式生理監視系統之設計與應用

Design and Applications of a Mobile Physiological Monitoring System

林淵翔(Yuan-Hsiang Lin)

指導教授 ： 詹國禎

國立臺灣大學/電機資訊學院/電機工程學研究所/博士(2004年)

https://doi.org/10.6342/NTU.2004.02408

摘要

本論文結合個人數位助理與無線區域網路建立一套行動式的病患生理監視系統，讓醫護人員可以方便且連續地監控病患在院內運送中的生理狀態，當有異常狀況發生時，可以做緊急的應變處理。在病人端，本論文設計一組可量測心跳、血氧濃度和三導程心電圖的多參數生理信號擷取模組，並將此模組整合在一個無線的個人數位助理平台上，形成一部輕巧且具無線傳輸能力的行動式生理監視裝置，具有連續的生理信號顯示、儲存和資料傳送的功能。透過無線區域網路，此裝置可以即時將病患的生命徵象信號傳送到一個遠端的管理單元，讓醫護人員可以存取和監控病患的即時生理資訊與病歷資料。同時為了提昇醫護人員的行動性與便利性，醫護人員可以使用其行動設備，如個人數位助理或掌上型電腦，與本論文所設計的軟體介面，經由無線網路從管理單元去存取遠端病患的即時生理資訊。此系統的雛型已設計開發與測試完成，並由醫護人員去評估本系統應用在院內病患運送上的效益，評估結果顯示醫護人員對此系統呈現高度的滿意程度(在5分為滿分的滿意尺度下有平均4.64分，標準差為0.53分的評估結果)。由於此系統具有高度的行動力，因此在病患運送的應用上，將可以提昇病患生理信號監控的彈性與便利性。

另一方面，為了提昇病患在運送時的安全性與連續血壓量測的便利性，本論文也提出了新的非侵入式連續血壓量測方法，從心電圖與血氧濃度的同時量測中去推估病患每一心跳的血壓變化，以減少量測導線數目。新方法使用上述所開發完成的生理信號監視裝置所擷取的光體積變化描述波形與心電信號，去萃取出脈波到達時間和正規化的光體積變化描述波形之波形寬度兩個參數，結合這兩參數去進行非侵入式連續收縮血壓的推估，並以侵入式血壓量測做為參考與比較的依據。在九個病患的實驗結果中，新的血壓推估方法可以提昇推估血壓和侵入式血壓之間的線性相關度，並降低其間的誤差標準差，因此將可以更正確的反映出病患血壓的高低變化。在未來的臨床使用上，只需結合一充氣式血壓計作校正後，便可以成為一套非侵入式的連續血壓量測系統。不但可以降低侵入式血壓量測可能發生的不便與感染等問題，此方法在整合本論文所開發的行動式病患生理監視系統之後，對於病患運送的應用上也可以間接降低量測導線與注射管路間的纏繞問題，進而提昇病患運送的安全性。

關鍵字

血氧濃度計 ； 行動式病患監視 ； 病患運輸 ； 血壓量測 ； 光體積變化描述波形 ； 生理監視器 ； 個人數位助理 ； 心電圖量測 ； 無線區域網路

並列摘要

This thesis proposes a mobile patient monitoring system, which integrates current personal digital assistant technology and wireless LAN technology. At the patient’s location, a wireless PDA-based monitor is used to acquire continuously the patient’s vital signs, including heart rate, three-lead ECG, and SpO2. Through the wireless LAN, the patients’ biosignals can be transmitted in real-time to a remote central management unit, and authorized medical staffs can access the data and the case history of the patient, either by the central management unit or the wireless devices. A prototype of this system has been developed and implemented. The system has been evaluated by technical verification, clinical test and user survey. The evaluation of performance yields high degree of satisfaction (mean = 4.64, standard deviation--SD = 0.53 in a five-point Likert scale) of users who used the PDA-based system for intra-hospital transport. The results also showed that the wireless PDA model is superior to the currently used monitors both in mobility and in usability, and is therefore better suited to patient transport.

In addition, this thesis also proposes new methods to estimate beat-to-beat systolic blood pressure by combining the pulse arrival time and normalized pulse width measurement derived from the waveforms of the ECG and PPG in our designed monitoring devices. These methods were examined in nine patients in ICU. Results showed the new methods have higher linearity and better precision than the methods using either pulse arrive time or pulse width only. Moreover, the improved method could be implemented into our mobile patient monitoring system, to minimize wire-wrapped problems during transport.

並列關鍵字

WLAN ； physiological monitor ； blood pressure measurement ； wireless LAN ； pulse oximeter ； vital-sign monitor ； photoplethysmogram ； ECG ； mobile patient monitoring ； patient transport ； PDA ； personal digital assistant

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