頭部外傷病患顱內壓複雜度之分析

Complexity Analysis of Intracranial Pressure in Patients with Traumatic Brain Injury

陸正威(Cheng-Wei Lu)

指導教授 ： 謝建興

元智大學/工程學院/機械工程學系/博士(2013年)

https://doi.org/10.6838/YZU.2013.00028

摘要

本研究利用多尺度熵(multiscale entropy)分析頭部外傷病患顱內壓的複雜度與病患預後之間的關聯性。病患的顱內壓及動脈血壓先以低通濾頻器去除呼吸波和脈波，再以多尺度熵計算所餘留慢波的複雜度指數(Complexity Index)。結果顯示若將病患以格拉斯哥結局量表(Glasgow Outcome Scale)分組，則各組間的顱內壓、壓力反應性指數(pressure reactivity index)和顱內壓複雜度指數有統計上的差異，P值分別為小於0.0001、等於0.001和小於0.0001。若將病患的預後二分為存活及死亡或是有利及不利，顱內壓複雜度指數區分這些預後的能力最顯著，其區分存活及死亡的F值為28.7，P 值小於0.0001，而區分有利及不利的預後，其F 值為17.21，P 值小於0.0001。此外利用多變數邏輯迴歸分析也確認顱內壓複雜度指數為預測病患預後的獨立因子，其P 值小於0.0001。本研究的結果顯示，頭部外傷病患顱內壓的慢波以多尺度熵計算出的複雜度，和病患的預後有顯著的相關性。

關鍵字

複雜度 ； 顱內壓 ； 多尺度熵 ； 預後 ； 脈波 ； 慢波 ； 頭部外傷

並列摘要

The present study applied multiscale entropy analysis to investigate the correlation between the complexity of intracranial pressure waveform and outcome after traumatic brain injury. Intracranial pressure waveforms were lowpass filtered to remove the respiratory and pulse components and then processed using a Multiscale Entropy algorithm to produce a Complexity Index. We identified significant differences across groups classified by Glasgow Outcome Scale in intracranial pressure, pressure-reactivity index and Complexity Index of intracranial pressure (P < 0.0001; P = 0.001; P < 0.0001, respectively). Outcome was dichotomised as survival/death and also as favourable/unfavourable. The Complexity Index of intracranial pressure achieved the strongest statistical significance (F = 28.7; P < 0.0001 and F = 17.21; P < 0.0001, respectively) and was identified as a significant independent predictor of mortality and favourable outcome in a multivariable logistic regression model (P < 0.0001). The results of the present study suggest that complexity of intracranial pressure slow waves assessed by multiscale entropy was significantly associated with outcome in brain injury patients.

並列關鍵字

complexity ； intracranial pressure ； multiscale entropy ； outcome ； pulse waves ； slow waves ； traumatic brain injury

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