血流與心率評估手術過程中自主神經之活性經由傅立葉轉換並與希伯特黃轉換做比較

Peri-operatively Evaluation the Activity of the Autonomous Nervous System via Blood-flow and Heart-rate variability using Fourier Transform in Comparison with Hilbert-Huang Transform

陳裕仁(Yu-Jen Chen)

指導教授 ： 謝建興

元智大學/工程學院/機械工程學系/碩士(2009年)

https://doi.org/10.6838/YZU.2009.00250

摘要

麻醉對於現代醫學的發展有極大的影響力；隨著麻醉技術的進步，外科醫師在手術中可以有效的對病患做醫療，病患於手術中更是毫無知覺。由於藥物的特性，麻醉醫師在做麻醉時可以針對三個主軸施打藥劑：知覺(Unconsciousness)、痛覺(Analgesia)、肌肉鬆弛(Muscle Relaxation)，三者於手術中需達到適量的平衡，才算是一個完整的麻醉。
至於麻醉深度的判定，一直都沒有明確的界定，所以需要專業的麻醉醫師用多年來的經驗觀察病患的生理訊號(心跳、血壓、SpO2)來給予適當的給藥濃度，使病人得到安全舒適的麻醉過程。近年來許多研究利用心率變異來研究自主神經做動的情形，冀以此做為麻醉深度的判斷，美中不足的是心電圖易被麻醉藥物、呼吸速率和手術中使用的電刀所產生雜訊所影響，帶給麻醉醫師錯誤的訊息，因此本研究加入了血流的分析來輔助參考。Atropine 與 Glycopyrrolate是在手術中時常用到的肌肉鬆弛劑，但經證實此藥物也會抑制副交感神經的作動。因此本研究將以是否使用此藥物做為變因，再利用工程理論來分析病患在全身麻醉過程中，血流變異和心率變異在高低頻的變化，最終達到輔助麻醉醫師能即時了解病人的真實狀況與特性，增加麻醉過程的安全性。
在本研究之前，先前的研究學生石沛豐已在台灣大學附屬醫院的開刀房中，收集10位接受Atropine，10位接收Glycopyrrolate和10位未接受以上藥物的耳鼻喉手術病患於開刀過程中全程的心電圖與血流數據，且運用希伯特黃轉換來分析病患的血流變異和心率變異，並找出自主神經的作動變化。隨後在本研究中利用傅立葉轉換分析這些數據，來驗證希伯特黃轉換的結果是否正確，並比較兩者對於心率與血流訊號的分析成果。最終經由傅立葉的分析後發現希伯特黃轉換可以有效的將血流中的自主神經變化分析出來，並且觀察到連續的變化。

關鍵字

麻醉深度 ； 心率變異 ； 血流變異 ； 傅立葉轉換 ； 希伯特黃轉換 ； 耳鼻喉手術

並列摘要

Anesthesia of surgery was a great contribution to medical development. Surgeon can make superior medical treatment for patient during operation by anesthesia; the patients have no sense of pain at all in the general anaesthesia. Utilizing the characteristics of the medicine anesthetist could emphasize the three momentous conditions while anaesthetizing such as unconsciousness, analgesia and muscle relaxation. For this reason the dose of drug needs to be up to right amount of surgery, and we define that complete anesthesia.
Evaluation for the depth of anesthesia is dependent on patient’s physiological signal and the sophisticated anesthetist’s experience to offer proper medicine that make patients have the best and safest anesthesia process. According to previously studies, heart rate variability (HRV) is a promising physiological signal for assessing autonomous nervous system activity. However, electrocardiogram (ECG) can be affected by anesthesia drugs, breathing rate and electrical equipments such as the electric knife. Because of these reasons they may show anesthetist wrong information. Atropine is a common drug for muscle relaxation while anesthetize, but it was verified that will block parasympathetic`s activity which made anesthetist judged no longer by heart rate. This study will compare Atropine and Glycopyrrolate with none of Atropine, by using innovative analysis algorithms to observe the autonomous nervous system activity changed during surgery. In this study we suggest blood flow to investigate the depth of anesthesia.
Before this research, previous study has collected the physiological signals from 20 patients with Atropine or Glycopyrrolate and 10 patients with normal medicine who accepted otolaryngological operation. Hilbert-Huang Transform (HHT) was applied on blood flow and heart rate. In this research, we used Fast Fourier Transform to verify that HHT can analyze the changes of ANS from blood flow variability and heart rate variability.

並列關鍵字

Blood flow variability ； Heart rate variability (HRV) ； depth of anesthesia (DOA) ； autonomous nervous system (ANS) ； Hilbert-Huang Transform (HHT) ； Fourier Transform

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