運用多尺度熵於植入式中央靜脈輸液管Port-A病患之麻醉術後身體平衡能力恢復之研究

Postural balance ability analysis for outpatients after Port-A surgery in anesthesia using multiscale entropy

蘇修儀(Hsiu-Yi Su)

指導教授 ： 江行全

元智大學/工程學院/工業工程與管理學系/碩士(2009年)

https://doi.org/10.6838/YZU.2009.00087

摘要

目前門診手術出院的準則是觀察病患之基本生理現象，缺乏評估患者身體平衡能力的指標。為了避免患者因麻醉藥物代謝不完全而發生跌倒的情況，本研究之目的為觀察使用不同麻醉藥之病患的身體活動能力可恢復至手術前狀況所需的概略時間，年齡對麻醉術後身體平衡恢復方向之關係，以及不同年齡層間所需的恢復時間。本研究之平衡能力評估系統希望可輔助醫護人員評估門診手術患者離開醫院之參考，更進一步期望提升病患離開醫院之安全性。本研究受測者主要為某醫學中心腫瘤科門診須植入內植式中央靜脈輸液管Port-A之87位病患。研究之實驗設計在術前及術後三個時間點收集病患站立之壓力中心點資料，經由經驗模態分解方法獲得高頻訊號，再利用多尺度熵的複雜度概念分析及評估受測者術前與術後身體平衡能力之差異。
研究結果發現使用複合麻醉藥之病患身體平衡能力約在進入恢復室休息65分鐘至85分鐘之間恢復，而使用單一麻醉藥之病患身體平衡能力約在休息45分鐘後逐漸恢復。此外，兩種組合麻醉藥物之受測者，可由身體平衡的左右方向來區分受測者所屬的族群。使用複合麻醉藥之中青年族群，麻醉術後之身體左右及前後平衡能力在術後休息65至85分鐘之間恢復接近至術前。使用單一麻醉藥者，麻醉術後之身體左右平衡能力在術後休息45分鐘後逐漸恢復接近至術前，而身體前後之平衡能力在術後休息45分鐘時已恢復接近至術前。使用複合麻醉藥之老年族群患者，麻醉術後之身體平衡能力在術後休息45分鐘後恢復接近至術前。使用單一麻醉藥者，其身體左右及前後的平衡能力在實驗設計的45分鐘內已恢復接近至術前。在目前兩類麻醉藥之組合下，身體平衡能力的左右方向受麻醉藥物影響而恢復的較慢。本研究經實驗觀察與結果認為，麻醉確實會影響身體平衡能力，建議衡量身體平衡能力的準則可納入門診手術患者離院之參考。

關鍵字

門診手術、麻醉恢復、壓力中心點、經驗模態分解方法、多尺度熵、 複雜度

並列摘要

Currently, the criterion for hospital discharge after postural surgery is evaluated by using basic physiological indices of the patients; an index for evaluating the body balance of the patient is ignored. To avoid patient failing due to incomplete metabolism of the anesthetic, this study aims to observe the approximate time required for patients using various anesthetics to recover pre-surgical physical activity, the relation between age and balance recovery after the use of anesthetic, and the required recovery time for different age groups. The balance evaluation system used in this study aims to assist the nurse to evaluate whether the ambulatory surgery patient may leave the hospital by providing references; it further aims to improve the safety of the patient after leaving the hospital. The subjects of the study were 87 patients who receive Port-A surgery from a medical center. The study was designed to collect standing center of pressure (COP) from the patients at 3 time points (45min., 1hr., and 2 hrs.) after the surgery; through empirical mode decomposition, high frequency signals are obtained. Then, complexity analysis of the multiscale entropy and evaluating the subject balance variation were performed before and after the surgery.
The study found that patients who used combined anesthesia recovered their balance after approximately 65-85 minutes in the recovery room; whereas, patients who used single anesthesia gradually recovered their balance after approximately 45 minutes. In addition, the direction of the balance could be used to differentiate the type of anesthesia the subject received. The medio-lateral (ML) and anterior-posterior (AP) balance of the youth-middle age group that used combined anesthesia almost recovered to the presurgical condition after 65-85 minutes of rest. The ML balance of the single anesthesia users gradually recovered to the presurgical condition after 45 minutes of rest while the AP balance almost had recovered to the presurgical condition at that time. The balance of the elder group that used combined anesthesia had almost recovered to the presurgical condition after 45 minutes of rest and the ML and AP balance of the elder group that used single anesthesia had recovered within 45 minutes according to the study design. For the two anesthesia types studied, we found that the ML balance was affected more by the anesthesia with a slower recovery process. The study observed that anesthesia indeed affects balance ability, and suggested that the balance ability evaluation would be included as a reference index for the hospital discharge of ambulatory surgery patients.

並列關鍵字

Port-A, anesthetic recovery, center of pressure (COP), empirical mode decomposition (EMD), multiscale entropy (MSE), complexity

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