以經驗模態分解法探討全膝關節置換術病患的缺血-再灌流的影響

Using Empirical Mode Decomposition Applied in Ischemia-Reperfusion of Total Knee Replacement Patients

王佑榮(Yo-Jung Wang)

指導教授 ： 謝建興

元智大學/工程學院/機械工程學系/碩士(2007年)

https://doi.org/10.6838/YZU.2007.00310

摘要

意外事件為國人十大死因之一，而創傷佔其中重要的比例，且又以青壯年為多。如何降低嚴重創傷患者死亡率及併發症，一直是醫療團隊努力的方向。實證醫學及臨床累積的經驗已很清楚指出，及早且完全的急救復甦，是決定嚴重創傷患者預後的重要因素。
研究的主要目的是希望利用工程分析理論，建立創傷加護病房病患的診斷系統，來協助並指導整個嚴重創傷病患之急救復甦流程。不論是在急診或是加護病房，急重症患者的生命徵象（心跳、血壓、呼吸及體溫等的監測）都是最基本的，我們擷取其中的血壓訊號（Arterial Blood Pressure，簡稱ABP），希望能利用工程理論來建立血壓訊號與人體循環及各子系統間的關係。但由於嚴重創傷病患除了出血性休克外，通常還伴隨著大量的組織破壞及感染，病情複雜，為避免過多無法控制的變數干擾研究的進行，因此在研究的初期，我們希望先藉由較單純的“缺血－再灌流”模型，來協助建立組織缺血指標。我們選擇全膝關節置換術（Total Knee Replacement，簡稱TKR）的病患來進行研究初期資料的收集與分析，之後再進一步推展到較複雜的嚴重創傷病患。
本研究內容，先以經驗模態分解法，將複雜的血壓訊號分解成許多簡單部分，探討血壓訊號與下肢組織缺血的相關性指標（Ischemia Index），利用探究全膝關節置換術的病患下肢的缺血程度及生理病理變化。

關鍵字

創傷急救 ； 組織缺氧再灌流 ； 動脈血壓 ； 經驗模態分解法 ； 全膝關節置換術

並列摘要

The important purpose of this study is to design an online monitor system for the resuscitation of traumatic shock at the trauma intensive care unit. The trauma critical care presents a variety of challenges. The major causes responsible for the mortality in the 1st hour are head injury and hemorrhagic shock from thoracic vascular injury, and that for late mortality is multiple organ failure. One of the key factors for the progression from the initial tissue injury and hemorrhage to multiple organ failure is persistent tissue ischemia, which leads to death finally. It can’t be emphasized enough that to deliver an early and adequate resuscitation is very important to decrease the mortality and morbidity of major trauma patients.

The physiological signals, including arterial blood pressure（ABP）, heart rate and arterial oxygen saturation, are the common monitoring for the critical illness. However, they can’t simply reflect the adequacy of tissue perfusion and oxygenation. Venous oxygen saturation（SVO2）, arterial lactate concentration, and pH can indicate the shock status, though, they have the shortcomings such as time delay, cost consideration, influence by organ reserve and easy contamination by the clinical treatment. But, the traumatic patients usually accompany other complications and clinical treatments. In the initial stage, the study takes the simple model which is total knee replacement（TKR）operation to avoid the uncontrollable factors which will influence the experiment.

Hence, in this study, ABP is analyzed with empirical mode decomposition in order to establish an effective ischemic index for accessing the pathophysiology of ischemia-reperfusion injury.

並列關鍵字

Trauma Resuscitation ； Ischemia-Reperfusion Injury ； Arterial Blood Pressure (ABP) ； Empirical Mode Decomposition ； Total Knee Replacement

參考文獻

[1]. Eugene N, Bruce, 2001 Biomedical Signal Processing and Signal Modeling, John Wiley & Sons, Inc.

[3]. Norden E. Huang1, Zheng Shen2, Steven R. Long3, Manli C. Wu4, Hsing H. Shih5, Quanan Zheng6, Nai-Chyuan Yen7, Chi Chao Tung8 and Henry H. Liu9: The empirical mode decomposition and the Hilbert spectrum for nonlinear and non-stationary time series analysis. R. Soc. Lond. A 1998; 454, 903-995

[4]. Regel G, Grotz M, Weltner T, Sturm JA, Tscherne H, “Pattern of organ failure following severe trauma.” World Journal of Surgery. 20（4）:422-9, 1996 May

[5]. Nast-Kolb D, Waydhas C, Gippner-Steppert C, Schneider I, Trupka A, Ruchholtz S, Zettl R, Schweiberer L, Jochum M, “Indicators of the posttraumatic inflammatory response correlate with organ failure in patients with multiple injuries. Journal of Trauma-Injury Infection & Critical Care. 42（3）:446-54; discussion 454-5, 1997 Mar.

[7]. Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP. “The natural history of the systemic inflammatory response syndrome （SIRS）: a prospective study.” JAMA 1995;273:117-23.