2017-08-012024-05-15https://scholars.lib.ntu.edu.tw/handle/123456789/663847摘要：在心跳停止時，若病患產生了心室顫動(ventricular fibrillation)等致命性的心室心律不整，電擊除顫治療(electric shock，ES)是唯一已被證實有效的治療方法。然而，在電擊除顫治療的過程中，所給予的電擊除顫能量與次數愈多，心肺復甦急救之後的心臟功能失調就愈嚴重。這些電擊除顫後的心臟功能失調包含了電擊除顫後的心律不整以及無法成功除顫。如何在適當的時機點給予電擊除顫，以減少不必要之無效電擊的次數，並提高電擊成功率，進而減少心肺復甦後心臟功能損傷與改善心跳停止病患復甦後心臟功能失調，是目前心肺復甦研究的重點之一。因此，在本計畫中，本研究團隊想要分別藉由動物實驗與臨床研究來分析心室顫動的心電圖波形與電擊除顫成功與否的關聯性，試圖建立心電圖波形分析的模型用以預測適當的電擊除顫時機，並進一步以動物實驗跟臨床病患資料加以驗證。此外，在本計畫中本研究團隊亦藉由血行動力學、組織學檢查與心臟酵素來評估心臟灌流之改變與心臟組織之傷害，並探討心電圖波形分析的模型與心臟灌流和心臟組織傷害之關聯性。在動物研究部分，本研究團隊將執行兩個階段的動物實驗。在第一階段實驗裡，本研究團隊將利用已建立的心室顫動心跳停止之動物模型，收集急救復甦中成功被電擊去顫的研究動物與不成功的研究動物。主要的分析項目在於比較兩組之間的VF waveform 不同之處，用以建立波型分析的新方法，並與已知的VF waveform 方法如AMSA 與DFA 比較；此外亦收集研究動物急救復甦時的血行動力學數據、心肌酵素與組織學變化，探討VF waveform 的變化與心臟功能的關聯性。第二階段則是利用在第一階段的VF waveform 分析所得到的方法與數據，進一步撰寫即時波型分析程式與設計訊號處理晶片，並利用已建立的動物心室顫動模型來驗證VF waveform 分析方法的準確性，並與已知的VF waveform 方法比較。在臨床的研究計劃裡，本研究團隊將收集突發性心跳停止病患在急診室急救時的致命性心律不整與電擊除顫心電圖波型，根據動物實驗所得到的結果加以分析，並比較除顫成功與不成功病患之間的心電圖波型差異，以建立臨床上突發性心跳停止病患發生致命性心律不整時電擊除顫成功與否的重要數據與閥值。此外，亦收集急救時重要的急救相關及臨床病程變項資料，進一步分析心電圖波型的變化與這些變項的關聯性。此一研究結果可為心室顫動之心跳停止提供心電圖波形分析與組織學檢查及血液中的心肌酵素之完整資料。更可進一步應用於臨床心跳停止病患復甦急救時之心室顫動的電擊除顫，減少這些病患的不必要之電擊除顫傷害並改善急救復甦時的心臟灌流，而期可進一步利用此研究結果改善心肺復甦急救的流程與重症照護。<br> Abstract: Electric defibrillation is the only effective treatment for fatal ventricular arrhythmias. However, thedefibrillation itself results in myocardial injury, both morphological and functional. Higher energy andmore unsuccessful defibrillation delivered during cardiopulmonary resuscitation results in more severepost-resuscitation myocardial dysfunction. The post-defibrillation myocardial dysfunction includesarrhythmia and unsuccessful defibrillation. The optimal timing of electric defibrillation and preventionof unnecessary unsuccessful defibrillation are key points in improving post-cardiac arrest dysfunctionand also critical issues in the research of cardiopulmonary resuscitation.In the present study, we would like to analyze the waveform of ventricular fibrillation (VF) andfind its correlation with defibrillation success thorough both animal and human researches. We mean toestablish the real-time feedback model to predict the optimal timing of defibrillation and validate themodel by using laboratory animal experiment and clinical human data. Besides, we will also use thehemodynamics, histological examination and cardiac enzyme to evaluate coronary perfusion andmyocardial damage, and further establish the association between waveform analysis and myocardialinjury.The animal study will have two stages. In the first stage, we will use the established animal modelof VF cardiac arrest to study the waveform difference between the successfully and unsuccessfullydefibrillated animals and try to establish the new methods to analyze VF waveform. We will alsocompare the new methods with the well-known methods such as amplitude spectrum area (AMSA) anddetrended fluctuation analysis (DFA). The correlation between waveform change and myocardialfunction will also be evaluated by hemodynamic, histological examination and cardiac enzyme. In thesecond stage, we will design a real-time feed back program and create a signal processing chip. Byusing the new machine and established animal model of VF cardiac arrest, we can test and validate theeffectiveness of new methods of waveform analysis.In the clinical study, we will collect the ECG and clinical characteristics from sudden cardiac arrest.In addition to establish the analysis model and predicting threshold for human, we will also validate themodel and threshold. Besides, the correlation between VF waveform and clinical characteristics willalso be evaluated.The results of the study would provide the comprehensive data of ECG waveform, histologicalexamination and cardiac enzyme of VF cardiac arrest patients. We may apply these results to theclinical practice to propose a model which suggests an optimal timing of defibrillation and avoidsunnecessary defibrillation, and thus improves the post-defibrillation myocardial function.心室顫動電擊除顫波形分析心電圖突發性心跳停止除顫時機ventricular fibrillationdefibrillationwaveform analysiselectrocardiogramsudden cardiac arrestdefibrillation timing