| 研究生: |
巫建興 Wu, Jian-Xing |
|---|---|
| 論文名稱: |
利用定量式超音波與光學技術於血管阻塞評估 Quantitative Ultrasound and Optical Technology for Vascular Occlusion Assessment |
| 指導教授: |
陳天送
Chen, Tain-Song |
| 學位類別: |
博士 Doctor |
| 系所名稱: |
工學院 - 生物醫學工程學系 Department of BioMedical Engineering |
| 論文出版年: | 2014 |
| 畢業學年度: | 102 |
| 語文別: | 英文 |
| 論文頁數: | 115 |
| 中文關鍵詞: | 周邊血管疾病 、超音波 、都卜勒 、光體積描述波形 、混沌同步技術 、糖尿病 、洗腎患者 |
| 外文關鍵詞: | Peripheral vascular disease, Ultrasound, Doppler, Photoplethysmography (PPG), Optical technology, Chaos synchronization, Diabetics, Dialysis patients |
| 相關次數: | 點閱:104 下載:0 |
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血管阻塞相關疾病為國人常見死因併發症之一,其中周邊血管疾病(PVD)是一種普遍的血管疾病和慢性疾病,常好發在糖尿病與長期洗腎患者,也與心血管疾病和神經損傷風險的增加有密切關係。周邊血管疾病若沒有得到充分治療與控制,常會引起缺血性胸痛、傷口癒合不良與廔管阻塞等症狀,且程度會隨著年齡增長而更趨嚴重,因此診斷與監測病患的周邊阻塞血管疾病有其必要性。本研究將結合都卜勒超音波和同步光學技術建立一套周邊血管偵測系統,除了提供臨床患者血管阻塞程度外,也能清楚了解相對應的解剖位置與血流資訊,作為診斷與治療時的參考,降低治療時的風險。本論文第一部份是利用多重位置法搭配自適性彩色關聯分類器,實現都卜勒超音波之洗腎廔管阻塞分析系統,藉此即時評估廔管的阻塞程度。此方法主要是依據血流動力學並配合無因次參數,來擷取與量化管腔內血流的都卜勒超音波特徵值;通過動脈吻合點與靜脈吻合點的參數資訊,計算出相對應的雷諾係數和阻抗係數,藉此評估廔管整體的阻塞程度與位置。本方法可以將結果直接對應到所關聯的彩色分類器,將阻塞程度利用顏色即時顯示給臨床人員,在30位長期洗腎病患的測試結果中,本方法在阻塞程度與位置的診斷上具有95%以上的準確度。本論文第二部份是利用同步光學技術來評估周邊血管,近來許多文獻研究指出,糖尿病患的周邊血管疾病常好發在下肢,此時下肢末端微循環的光體積描述波形(PPG)會發生不同步的現象,因此同步誤差是相當好的診斷依據。本章節利用混沌同步技術來偵測波形的同步誤差,同時配合狼群演算法(WPS)作為分類器的設計基礎。為加快演算的速度,本研究同時將混沌同步演算法實現於硬體電路中,在實際30位臨床病患的分析結果中顯示,混沌同步(CS)處理方法可以有效偵測波形的同步誤差,相較於傳統的時域方法上有更好的穩定與準確度(>90%)。另外與現今臨床上常見的踝肱血壓指數(ABPI)檢查結果相比,除了有準確度上的優勢外,在量測上也較為簡易且不會因血管硬化而誤判。本論文證實,結合都卜勒超音波和同步光學技術能有效偵測周邊血管疾病,不論是洗腎患者因長期洗腎所導致的手臂廔管阻塞,或是糖尿病患下肢的血管病變等,皆有良好的偵測能力。此外在臨床實驗中也發現,本論文所提出的方法比現有的臨床檢查來得更加準確且簡單量測,未來可以收集更多的臨床資料來驗證系統的可信度外,也能藉此瞭解相關的致病機轉,提升臨床醫療品質。
Vascular occlusions have become the major causes of death in Taiwan. Among them, peripheral vascular disease (PVD) is a widespread vascular disease and chronic disease in patients with diabetics and long-term dialysis patients, and is also associated with increased risk of cardiovascular disease and nerve damage. Inadequate control or treatment of PVD usually causes ischemic chest pain, poor wound healing and arteriovenous shunt stenosis, and the symptoms become severer with age. Therefore, achieving accurate diagnosis and monitoring of PVD via assessing blood vessels are important issues. This research combines Doppler ultrasound with optical technology to develop a PVD diagnosis system for clinical uses, which provides not only the degrees of stenosis (DOS), but also anatomical locations and blood flow physiology information for clinical physicians, lowing the risk arising from treatment. The first part of this study is to real-time evaluate arteriovenous access occlusion using Doppler ultrasound based on multiple-site hemodynamic analysis and an adaptive color relation classifier. In this study, we proposed a method based on hemodynamic analysis with dimensionless numbers to capture and further quantify the feature values of Doppler ultrasound extracted from intraluminal blood flow. The ratio of the supracritical Reynolds (Resupra) number and the resistive (Res) index were calculated via the peak-systolic and peak-diastolic velocities of blood flow from the arterial anastomosis sites (A) to the venous anastomosis sites (V) to quantitate the DOS at multiple measurement sites. After that, the results were mapped with an adaptive color relation classifier to real-time display the DOS. The examination results from thirty long-term dialysis patients showed that this proposed method performed well in DOS and occlusion site detection, with >95% of accuracy. The second part of this study is to evaluate PVD using optical technology technology. Recently, many studies indicated that PVD in patients with diabetics often occurred in the lower limbs, and the microcirculation of those lower limbs appeared asynchronous pulses in photoplethysmography (PPG) signals, making it a reliable PVD diagnostic method. In this study, a Sprott chaos synchronization (CS) classifiers based on PPG is proposed for asynchronous detection, and a wolf pack search (WPS) algorithm is selected as a classifier unit. Furthermore, to accelerate the speed of calculation, this study implemented Sprott CS algorithms in the hardware circuit. The analysis results from thirty clinical patients showed that the proposed Sprott CS technique could effectively detect the asynchronous pulses, with better stability and accuracy (> 90%) compared with traditional time-domain method. In addition, compared with the ankle-brachial blood pressure index (ABPI) technique, this proposed system performed better accuracy, relatively simple operation, and less false positives from vascular sclerosis. In summary, this study confirmed that combined use of the Doppler ultrasound and optical technology is a potential candidate method to effectively evaluate the PVD caused by long-term dialysis or vascular disease of lower-extremity in patients with diabetics. The proposed system provides useful information with better accuracy and convenience for clinical examination. Future works include collecting more clinical data for verifying the reliability of this system, investigating the relevant pathogenesis of PVD, and improving the quality of clinical medical practice.
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校內:2019-08-26公開