血液透析患者大都在手臂上建立一條洗腎血液通道，稱之為動靜脈瘻管(Arteriovenous Shunt, AVS)，目的是讓動脈血能快速流經透析機回流到靜脈。動靜脈瘻管因長期受穿刺針刺激，血管通路內部可能會逐漸產生血管病變，發生狹窄情況，使動靜脈瘻管功能失效。動靜脈通路可以透過觸診感覺顫動與脈動、聽診器、杜普勒超音波或血管造影來做狹窄情況評估。目前杜普勒超音波或血管造影是有效的非侵入式技術，對於動靜脈通路預測有著高度的準確性，不過無法及時在洗腎單位執行，且皆需要昂貴的設備及另聘專職技術人員或由放射科醫師操作執行。依目前臨床判斷方式，是在洗腎前以理學檢查法或病人自己本身發現阻塞或狹窄後再進行手術，可預期瘻管使用期限已不長且改善的效果有限。此問題為血液透析患者長期的困擾，所以目的是希望以一預測模型並量化音頻能量方式，能夠迅速並準確的預測瘻管狹窄程度，且提供臨床上判斷的量化指標，協助洗腎病患提早發現狹窄情況就能提早治療，恢復動靜脈瘻管功能。動靜脈瘻管發生狹窄情形對於血行動力參數與聲音訊號會有明顯的影響。因此本研究藉由一個模擬血液透析患者的動靜脈瘻管血液動力系統，利用不同的瘻管狹窄模組來探討當發生多重狹窄程度的血液動力學變化情況，來探討瘻管血流狀態的現象，且利用自迴歸模型來建立可預測動靜脈瘻管狹窄之音頻參考模型。根據數據顯示，在三個多重狹窄的變數模組所計算得不同狹窄程度時的瘻管流量，當狹窄越大靜脈分流流量越少，而且當狹窄達一定程度時，有兩個狹窄的動靜脈瘻管流量會受到較高狹窄程度的影響。在壓力方面推測出模組的壓力差是因為受到水頭損失原理的狹窄所造成的壓力損失。在動脈雜音描記法之音頻分析方面，動靜脈瘻管發生顯著程度(significant)狹窄時，第二主頻頻譜密度值(PSD-2)的能量會有增加的趨勢，大部分高能量(PSD-2 > 0.6)發生情形是在高狹窄段程度，所以可以推測，當PSD-2發生高能量時，就是動靜脈瘻管發生高狹窄程度的關鍵時刻，此為預測模型之關鍵參數。然而，管路流量大小及收音位置差異之因素，對窄化模組之預測均無顯著差異。

This study has developed a Phonoangiography method for using in a home-based care system to evaluating arteriovenous shunt (AVS) stenosis in hemodialysis patients. Phonoangiography is a noninvasive tool for auditing the local fluid motion in the narrowed arteries and assessing arterial dysfunction. A bruit spectral analysis could be considered a valuable noninvasive method for quantifying the severity of vessel stenosis. Using Autoregressive Model (AR Model), a specific mock model has been set up to simplify the modeling of blood flow condition and to analyze the spectrum. It follows that a more precise relationship of phonography to stenotic lesions can be observed. When PSD-2 occurs when high energy, arteriovenous fistula is a critical time high degree of stenosis occurred. This is the forecast of key parameters of the model.

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