邵耀華臺灣大學:應用力學研究所李建達Li, Jain-DaJain-DaLi2010-06-022018-06-292010-06-022018-06-292008U0001-2201200821244000http://ntur.lib.ntu.edu.tw//handle/246246/184690對糖尿病的病患而言，自主神經病變可發生於第一型的糖尿病，也可發生於第二型的糖尿病。自主神經病變可能在患者被診斷為糖尿病時就發生了，其會影響心血管系統、消化道系統、泌尿道系統、排汗功能、代謝性的障礙及瞳孔異常，且與病患的死亡率有關，因此早期的診斷與治療是非常重要的。研究在於發展一套臨床設備，以脈波波速、動態心率變異度(DHRV)分析和平均動脈壓(MAP)來檢測自主神經系統的強度。用六個頻道之壓力感測器，同時量測身體六點之脈波，而測量出三組脈波波速，可比較左、右肢或上、下肢之脈波波速，加上心電圖計算其動態心率變異度，並將之推廣於量測自主神經之強度，和比較整體跟週邊對姿態改變的變化程度。驗的對象:控制組選擇正常、沒有循環系統疾病的人，共有六人一女五男，年齡23±2歲。糖尿病患組選擇沒有高血壓等其他心血管疾病，共10人七男三女，年齡為54±11歲。還有一組是糖尿病患有Charcot foot的病患2名男性年齡分別是37歲和50歲。當傾斜角度增加，下肢脈波波速變化率比上肢來得大，而且控制組比其他兩組都大。MAP變化率控制組為正，兩組病患為負。兩組病患的DHRV值比控制組小，而患有Chartcot foot的病患其值又比一般的糖尿病患小。以上結果顯示，這套非侵入性的檢查設備可以檢測出自主神經的強度。In diabetes autonomic neuropathy may occur in Type1 and Type2. It may occur before being diagnosized and affect cardiovascular system, digestive system, Genitourinary system, sweat gland and metabolism. Autonomic neuropathy is relative to the mortality of the diabetes, so the early diagnosis and treatment are very important.his study is to measure the mean arterial pressure(MAP), dynamic HRV and the pulse wave simultaneously at four limbs by pressure receptors, and use the electrocardiogram as the reference to synchronize the recorded pulse wave at different vessels. Using the data to calculate the dynamic HRV(DHRV) and the pulse wave velocity(PWV). With the pulse wave velocity of different vessels and DHRV , we can understand the autonomic nerve activity and the local sympathetic nerve activity in different diseases and different sites. research 6 normal young people with no cardiovascular disease as control group. 5of them are male and 1 is female aged 23±2.The second group contains 10 people(7 males and 3 females), who have Diabetes mellitus(Type 2) without hypertension aged 54±11. The third group has only 2 males aged 50 and 37, are Diabetes mellitus(Type 2) patient with Charcot foot.hen the tilt-table tilts the change of PWV of lower limb is greater than upper limb. The change of PWV of lower limb in control group is greater than the other 2 groups. The DHRV of control is greater than the other 2 groups, and the DHRV of the patients with Charcot foot is much smaller. The change of MAP is positive in control, but negative in the other. Then we can prove that this technique can measure the activity of autonomic nervous sysyem.誌謝...........................................................I文摘要..................................................... II文摘要..................................................... III錄......................................................... .V目錄.......................................................VII目錄....................................................... IX一章 序論................................................. 1.1 前言.................................................1.2 文獻回顧.............................................2.3 研究動機及目的.......................................5.4 論文架構............................................ 6二章 研究原理.............................................. 7.1 糖尿病患的周邊神經病變.............................. 7.2 動脈壓調節機制...................................... 9.3 血管特性............................................11.4 自主神經系統之調節性............................... 12.5 心率變異度分析......................................13.5.1 時域分析 (Time domain) .........................13.5.2 頻域分析 (Frequency domain) ................... 13.6 脈波特性............................................14.6.1 脈波傳遞........................................14.6.2 脈波波速........................................15三章 實驗方法及設備....................................... 17.1 實驗方法............................................17.2 實驗設備............................................17.3 系統校正............................................19.4 實驗受試者..........................................19.5 實驗流程............................................20.6 資料處理與分析......................................20.6.1 動態心率變異度時域分析..........................21.6.2 脈波波速計算分析................................22 3.7 統計分析............................................ 22四章 結果與討論........................................... 23 4.1 波速變化率的比較.................................... 23 4.2 姿勢改變心跳和平均動脈壓的變化...................... 25 4.3 姿態改變對動態心率變異度的影響...................... 26 4.4 各參數間的關係...................................... 27 4.4.1 脈波波速變化率對患病時間的關係 ................. 27 4.4.2 MAP變化率和DHRV對患病時間的關係................ 27 4.4.3 脈波波速變化率、MAP變化率和DHRV間的關係........ 28 4.5 動脈壓調節機制...................................... 29五章 結論與未來展望....................................... 30 5.1 結論................................................ 30 5.2 未來展望............................................ 31考文獻..................................................... 32錄......................................................... 60目錄2.1 血管橫切面............................................ 382.2 壓力感受器位置........................................ 392.3 傾斜床實驗典型範例.................................... 392.4 脈波波速量測方法...................................... 402.5 心搏的一個週期........................................ 403.1 上下肢動脈............................................ 413.2 壓力感測器............................................ 423.3　壓力感測器線路配置示意圖.............................. 423.4 血壓計................................................ 423.5 電動傾斜床............................................ 423.6 系統訊號誤差校正圖.................................... 433.7 實驗步驟流程圖........................................ 443.8 Labview 資料擷取軟體介面.............................. 45 3.9 壓力波特徵點標準方法................................. 45 3.10 動態心率變異度時域分析步驟.......................... 46 3.11 三次微分取得正確foot點............................. 47 3.12 氣帶及心電圖貼片的位置.............................. 484.1不同角度波速的變化......................................494.2 脈波波速平躺狀態到傾斜60度的變化率.................... 504.3 心跳和平均動脈壓對姿態改變的變化率..................... 514.4 不同姿態下的平均動脈壓................................. 514.5 不同姿態下的心跳速率................................... 524.6 實驗過程中心跳對時間的關係............................. 534.7 RR變異度............................................... 534.8 正常人RR intervals在平躺和站立時的情況................ 534.9 動態心率變異度(DHRV)................................... 544.10 上肢波速變化率對糖尿病患病時間的關係(r=-0.35)......... 544.11 下肢波速變化率對糖尿病患病時間的關係(r=-0.73)......... 554.12 傾斜時動態HRV平均值對糖尿病患病時間的關係(r=-0.49)... 554.13 MAP變化率對糖尿病患病時間的關係(r=-0.61)............. 554.14 HR變化率對糖尿病患病時間的關係(r=-0.11).............. 564.15 上肢波速變化率對糖尿病患年齡的關係(r=-0.67)........... 564.16 下肢波速變化率對糖尿病患年齡的關係(r=-0.24)........... 564.17 HR變化率對年齡的關係(r=-0.39)......................... 574.18 上肢波速變化率對MAP變化率的關係(r=0.53)...............574.19 上肢波速變化率對DHRV平均值的關係(r=0.15)............. 574-20 下肢波速變化率對MAP變化率的關係(r=0.82).............. 584.21 下肢波速變化率對DHRV平均值的關係(r=0.67)............. 584.22 MAP變化率對DHRV平均值的關係(r=0.74).................. 584-23 本實驗不同姿態下的心跳速率............................ 594-24 本實驗不同姿態下的平均動脈壓.......................... 594-25 本實驗不同姿態下的HRV................................ 59目錄2.1 自主神經對內臟器官的影響............................... 372.2 Risk Factors for Diabetic Neuropathy...................373.1 受測者基本資料......................................... 383.2 會影響HRV的疾病........................................38application/pdf827002 bytesapplication/pdfen-US自主神經病變夏克氏足脈波波速心率變異度糖尿病Autonomic neuropathyCharcot footPulse wave velocityHRVDiabetes[SDGs]SDG3thesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/184690/1/ntu-97-R94543031-1.pdf