發(fā)布時(shí)間：2018-01-27 01:45

  本文關(guān)鍵詞： 心力衰竭 指南結(jié)構(gòu)化 多目標(biāo)優(yōu)化 快速參數(shù)估計(jì) 藥效仿真　出處：《浙江大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：在臨床治療中,心力衰竭的控制率很低,死亡率居高不下。造成以上問題的原因之一就是缺乏有效實(shí)施的心力衰竭疾病治療規(guī)范和優(yōu)化治療方案。本課題旨在運(yùn)用工程建模技術(shù),建立藥效仿真支持的心力衰竭疾病治療模型：將心衰臨床指南與多目標(biāo)優(yōu)化決策模型相結(jié)合構(gòu)造心衰決策模型,并通過藥效仿真模型預(yù)測(cè)治療效果,從而實(shí)現(xiàn)心力衰竭疾病的有效治療控制。課題具體實(shí)現(xiàn)的工作內(nèi)容如下： 1)對(duì)臨床數(shù)據(jù)進(jìn)行分析,篩選出與心力衰竭密切相關(guān)的特征參數(shù)。 2)對(duì)心衰指南和臨床經(jīng)驗(yàn)進(jìn)行知識(shí)梳理,采用結(jié)構(gòu)化流程表征。 3)運(yùn)用多目標(biāo)優(yōu)化模型對(duì)心衰狀況細(xì)化評(píng)估,并據(jù)此給予相應(yīng)治療方案：首先利用聚類分析方法將生理參數(shù)劃分為六個(gè)子類,采用隸屬函數(shù)獲取生理參數(shù)的模糊隸屬度,依據(jù)最小二乘估計(jì)原則和最大熵原理確定各參數(shù)的權(quán)系數(shù),進(jìn)而對(duì)各類生理參數(shù)的模糊隸屬度加權(quán)求和產(chǎn)生一級(jí)指標(biāo)值,最后根據(jù)六個(gè)一級(jí)指標(biāo)所反應(yīng)的心衰各層面狀況給予相應(yīng)的藥物治療。 4)對(duì)藥物治療效果進(jìn)行仿真預(yù)測(cè)�；谛难芙＜夹g(shù)和相關(guān)文獻(xiàn)報(bào)道,建立了藥效仿真模型和ACEI類藥物作用曲線。依據(jù)藥效曲線和患者基礎(chǔ)信息,即可以通過模型仿真方法得到某藥物作用下的血流動(dòng)力學(xué)預(yù)測(cè)情況。研究中建立了一種快速參數(shù)估計(jì)算法,通過可測(cè)的血壓參數(shù)估計(jì)模型參數(shù)值,進(jìn)而加快了整個(gè)藥效仿真的效率。 5)將得到的模型應(yīng)用于臨床病例試驗(yàn),驗(yàn)證模型效果。 對(duì)臨床病例的測(cè)試結(jié)果表明：心力衰竭疾病治療模型能全面的評(píng)估心衰狀況,依據(jù)心力衰竭各層面具體的嚴(yán)重程度給予相應(yīng)的治療方案,與實(shí)際給藥的吻合度達(dá)到91%,滿足臨床需求,是一種有效的個(gè)性化的治療方案。 本課題建立的心力衰竭疾病治療模型為心力衰竭治療提供了一種新思路,具有良好的應(yīng)用前景。
[Abstract]:In clinical treatment, the control rate of heart failure is very low. Mortality remains high. One of the causes of these problems is the lack of effective implementation of heart failure treatment standards and optimization of treatment programs. The purpose of this project is to use engineering modeling technology. To establish the model of heart failure treatment supported by pharmacodynamics simulation: combining the clinical guidelines of heart failure with the multi-objective optimization decision model, the decision model of heart failure was constructed, and the therapeutic effect was predicted by the simulation model of drug efficacy. In order to achieve effective treatment and control of heart failure disease. 1) the clinical data were analyzed and the characteristic parameters closely related to heart failure were screened out. 2) combing the knowledge of heart failure guidelines and clinical experience, using structured process representation. 3) the multi-objective optimization model was used to evaluate the state of heart failure, and the corresponding treatment plan was given. Firstly, the physiological parameters were divided into six subgroups by cluster analysis. The membership function is used to obtain the fuzzy membership degree of physiological parameters, and the weight coefficient of each parameter is determined according to the least square estimation principle and the maximum entropy principle. Furthermore, the weighted sum of fuzzy membership degree of various physiological parameters produces the first-order index value. Finally, the corresponding drug treatment is given according to the state of heart failure at each level reflected by the six first-class indexes. Based on cardiovascular modeling technology and related literature, the simulation model of drug efficacy and the action curve of ACEI drugs were established. According to the drug efficacy curve and patient basic information. In this paper, a fast parameter estimation algorithm is established to estimate the model parameters through measurable blood pressure parameters. Furthermore, the efficiency of the whole drug effect simulation is accelerated. 5) the model was applied to clinical trials to verify the effectiveness of the model. The results of clinical cases showed that: heart failure treatment model can comprehensively assess the state of heart failure, according to the specific severity of each level of heart failure to give the corresponding treatment. It is an effective and individualized treatment scheme to meet the clinical needs. The model of heart failure treatment provided a new idea for the treatment of heart failure, and has a good application prospect.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R312

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