模糊控制應用於神經外科加護病患顱內壓之控制

Fuzzy logic control applied in intracranial pressure of patients in neurosurgical intensive care unit

傅木(Mu Fu)

指導教授 ： 謝建興

元智大學/工程學院/機械工程學系/碩士(2002年)

摘要

在腦神經外科加護病房中，頭部外傷的病例常伴有顱內壓不穩定的現象，而造成整體病況的惡化及續發性損害病患。此不穩定的現象常由躁動所引起，可藉由顱內壓的監測與鎮靜劑的施打加以抑制，對於病況具有穩定的作用。又鎮靜劑長時間固定藥量的施打對於病人本身會產生不良的副作用，且對於藥劑成本的支出產生不必要的負擔。故鎮靜劑適時適量的調整將是對病患本身及醫療成本而言，達到最理想的狀態。
本研究的目的即以模糊邏輯為理論根源，在經由與醫師的確認，排除顱內壓影響因素較為複雜的病患，並固定使用的藥物，使實驗的影響因素降至最低之後，尋找出要控制標的「躁動」的訊號模式。而在醫師對於躁動的控制經驗做完善的整理之後，將病患的狀況經由儀器的監測、系統的判別、再做鎮靜劑量的回饋，並將醫師專業的臨床經驗加以吸收，做條列式的整理，成為可獨立作業的控制系統，以在加護病房的鎮靜控制方面達到完善的自動化醫療照護。其次，為了節省藥劑支出的成本，如何針對所使用藥物劑量進行適量的施打也是重點課題之一，而能夠盡量以最少的藥量達到臨床上可接受的控制效果，進而節省整體醫療成本。最後將針對文中所提之各控制方式，與原本加護病房中的手動調整藥量的方式，對病患的躁動抑制所產生的效果與影響，做一統計上的分析與比較，以觀察在療效與節省藥劑成本的考量之下成效最佳的控制模式。

關鍵字

神經外科加護病房 ； 顱內壓 ； 鎮靜劑 ； 模糊邏輯控制器

並列摘要

Most of the neurocritical ill patients with severe head injuries often follow intracranial pressure (ICP) unstable that may induce the increasing of ICP and serious complications. These situations often caused by agitation are able to be avoided by continuous intracranial pressure monitoring and proper sedative infusion. Furthermore, continuous sedative infusion during long term will induce side effects and financial loading unnecessary to the patients as well. That is the reason why the proper adjustment of sedative infusion plays such an important role in the neurocritical case.
The major goal of this thesis consists in using fuzzy logic theory to control the sedative infusion rate automatically to reduce the effect of agitation. By finding out the control target of signal pattern of agitation, an independent system which was built on notebook, syringe pump, and bedside monitor, has been designed to achieve the medical automation in intensive care unit by combining vital signs’ monitoring and sedative infusion of feedback control. Moreover, to save the expense of sedative drugs, it is important to control total amount of sedative drugs to the minimum in order to achieve the stable conditions of the patient. Finally, every control theory mentioned in the thesis has been compared with traditional manual adjustment of sedative infusion via statistical tests to do the evaluation.

並列關鍵字

neurocritical illness ； intracranial pressure ； sedative infusion ； fuzzy logic theory

參考文獻

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