- 學位論文
以溫度差熱影像探討下肢褥瘡成因之研究
A Investigation of Low Limbs Bedsore with Temperature Difference of Thermal Image.
摘要
下肢壓瘡多發生於下肢或四肢癱瘓的病患，主要的形成因素有壓力、溫度、剪力、濕度及營養等所造成的。傳統診斷的方法是用目視及皮膚的組織觸診，檢查其損害程度的不同以作為判斷的指標，這種主觀的判斷方法，將造成醫學診斷上的誤差。 本研究目的是利用紅外線熱影像儀，量測皮膚組織受局部壓力時溫度差的變化趨勢，來探討壓力、時間及體表溫度變化的相關性，提供診斷與治療的依據，做為評估壓瘡程度的重要指標。根據文獻數據來探討紅外線熱像儀可否做為臨床上，診斷下肢壓瘡的輔助工具。 本論文是使用紅外線熱影像儀SPECTRUM 9000MB-500及Vista Medical FSA UT1010壓力感測器，隨機拍攝在恆定持續的壓力下，15位正常人下肢的溫差熱影像。其左下肢設定為實驗組，以恆定的接觸介面壓力40-90 mmHg，持續施壓20-60分鐘，平均施加於左下肢中間部位做測試，右下肢則設定為對照組。並從特徵影像中圈選左和右下肢的上、中、下六個特徵區域，計算各區域的平均溫度分佈及標準差，分析並探討其相關參數，以預測溫度對於壓瘡的影響。 實驗結果顯示，受壓迫下肢的血流因受阻導致體表溫差變大，在受壓小於100mmHg且短暫受測時間，溫差皆在2.5℃以下。當下肢所承受的壓力越大或時間越久，造成局部血管扭曲、變形，進而影響到血流通過產生缺血的現象，所以溫度分佈差距越大，標準差亦會增加。在持續承受40mmHg的壓力，300分鐘以上的皮膚表面會有超過4℃的溫差產生。左右下肢檢測正確度透過ROC曲線分析為0.92具診斷意義，因此藉由本文的實驗分析方法，證明對於下肢癱瘓與潰瘍的病患，溫差熱像可以作為性迅速診斷的輔助工具。
並列摘要
The Lower Limbs Ulcer is often happened to the low limbs and paralyzed patient of four limbs resulted from the forming factor of pressure, temperature, shearing stress, moisture and nutrition etc.. Using visual and skin contacts to subjective diagnosis is the traditional estimate method; but its diagnosis is inaccuracy occasionally. This research purpose is to utilize the thermal imaging, examines the skin and tissue the variation tendency with difference temperature while receiving some pressure, discuss with pressure, time and dependence that body surface temperature change, offer and diagnose it with the therapeutic basis, estimate the important indicator which pressure sore grade. Compare according to document data, estimate the thermal imaging system could is it diagnose for clinic low limbs ulcer. This research investigates the influence situation of temperature to pressure sore using SPECTRUM9000MB-500 thermal imaging system and Vista Medical FSA UT1010 pressure system to gather the low limbs image of 15 normal persons at random at different pressure. The left low limbs are set up for the experiment group, with invariable contact interface pressure 40-90 mmHg, exert pressure for 20-60 minutes continuously, exert and test in the position in the middle of the left low limbs equally, the right low limbs are set up for the control group. Estimates the temperature distributions and standard deviations of six zones including upper, middle, lower of two lower limbs with the characteristic of thermal imaging. The experimental results are shown that the blood vessel of lower limbs loading pressure cause larger temperature difference of body surface and this temperature difference is below 2.5℃ at lower 100 mmHg and short time. The temperature difference distributions and standard deviations are more and more large as lower limbs loading heavy or long resulting in some blood vessel twist or distortion. The temperature difference is over 4℃ at the continuing situation of 40mmHg and above 300 minutes. Control the low limbs to measure correct degree and analysis for 0.92 meanings of diagnosing through ROC curve. At last, the experimental and thermal image analyzing methods can be the diagnosis auxiliary tool rapidly for paralysis patient and low limbs ulcer in this paper.