本文選題：嚴重意識障礙 + EEG�。� 參考：《杭州電子科技大學》2013年碩士論文

【摘要】：嚴重意識障礙患者是指由重型顱腦損傷、腦出血或梗死、電擊傷、心臟疾病、溺水等所導致的對周圍環(huán)境的感知具有障礙的患者（俗稱植物人）。嚴重意識障礙患者意識狀態(tài)分為植物狀態(tài)(VS, vegetative state)和最小意識狀態(tài)(MCS, minimally conscious state)。如何通過不同的刺激手段（如電刺激，聲刺激，光刺激等）對意識障礙患者進行有效促醒是醫(yī)學界面臨的難題之一。聲刺激（包括喚名刺激、音樂刺激）是目前臨床常用的促醒治療方法，然而如何對不同聲刺激的有效性如何進行評估，目前還缺乏明確的評估方法，因此探索聲刺激有效性評估方法具有重要的臨床應用價值。 腦電信號（EEG）具有時間分辨率高，成本低，無輻射性，適合床邊檢測等優(yōu)點，能夠準確、客觀的地反映出大腦功能活動的變化情況。本文以腦電技術作為研究手段，通過對比分析被試在不同類型聲音（喚名、音樂）刺激下的EEG信號特征值的變化，判別何種刺激引發(fā)對患者最大腦電響應，以此作為刺激有效性評定依據(jù)；同時，根據(jù)不同意識狀態(tài)的患者對同一聲音刺激的不同反應程度，實現(xiàn)意識狀態(tài)的輔助判定。本論文的主要研究工作如下： （1）背景及現(xiàn)狀的介紹：介紹在嚴重意識障礙患者診治領域面臨的醫(yī)學問題及腦電技術在意識狀態(tài)判定和預后方面的研究概況和發(fā)展趨勢。 （2）實驗方案設計：包括實驗對象的選擇、實驗范式的確定、實驗材料的應用等。 （3）聲刺激有效性的評估：本文分別選擇了小波能量值和樣本熵作為腦電特征指標，統(tǒng)計分析MCS和VS在喚自名刺激、喚他名刺激和音樂刺激下三種不同聲音刺激前后的腦電響應程度，比較不同聲刺激手段的有效性。研究表明：首先，在喚自名刺激前后，MCS和VS的腦電小波能量值均具有顯著性的變化，而樣本熵均無顯著性的變化。其次，在喚他名刺激前后，MCS和VS的小波能量值、樣本熵均無顯著性變化。最后，在音樂刺激前后，MCS的小波能量值有顯著性變化，樣本熵無顯著性變化；而VS的小波能量值、樣本熵均無顯著性變化。因此，腦電小波能量值能夠有效地實現(xiàn)對不同聲刺激的有效性評估，而樣本熵不適于評估聲刺激的有效性。 （4）意識狀態(tài)的分類研究：本文以喚自名刺激和音樂刺激下的8導小波能量值為特征參數(shù)，應用K-調(diào)和均值聚類方法，，對33例意識障礙患者進行了意識狀態(tài)判別，其判別正確率達78%。
[Abstract]:Severe consciousness disorder refers to the patients with severe brain injury, cerebral hemorrhage or infarction, electric shock injury, heart disease, drowning and so on, who have difficulty in perceiving the surrounding environment (commonly known as vegetative). The state of consciousness of patients with severe disturbance of consciousness is divided into vegetative state (VS, vegetative state) and minimal state of consciousness (MCS, minimally conscious state). How to effectively awaken the patients with consciousness disorders through different stimuli (such as electrical stimulation, acoustic stimulation, optical stimulation, etc.) is one of the difficult problems in the medical field. Acoustic stimulation (including name-calling stimulation, musical stimulation) is a commonly used method of wake-up therapy. However, how to evaluate the effectiveness of different acoustic stimuli, there is still a lack of clear evaluation methods. Therefore, it has important clinical application value to explore the evaluation method of acoustic stimulation effectiveness. EEG has the advantages of high time resolution, low cost, no radiation, suitable for bedside detection, and can accurately and objectively reflect the changes of brain function. In this paper, EEG technique was used as a research tool. By comparing and analyzing the changes of EEG signal characteristic values under different types of sound (name, music) stimulation, we determined which stimulation triggered the greatest EEG response to the patient. At the same time, according to the different degree of response to the same sound stimulation, the auxiliary judgment of the state of consciousness can be realized according to the different degree of response of patients with different states of consciousness to the same sound stimulation. The main work of this thesis is as follows: (1) the background and present situation: the medical problems in the field of diagnosis and treatment of patients with severe consciousness disorder and EEG technology in the judgment and prognosis of consciousness state are introduced. Research overview and development trend. (2) Experimental scheme design: including the selection of experimental subjects, (3) Evaluation of the validity of acoustic stimulation: wavelet energy value and sample entropy were selected as EEG characteristic indexes, respectively, and MCS and vs were used as self-named stimuli. The EEG responses before and after three different sound stimuli were compared to compare the effectiveness of different acoustic stimuli. The results show that: firstly, the wavelet energy values of MCS and vs have significant changes before and after self-naming stimulation, but the sample entropy has no significant change. Secondly, the wavelet energy and entropy of MCS and vs were not significantly changed before and after the stimulation. Finally, before and after the music stimulation, the wavelet energy value of MCS has significant change, but the sample entropy has no significant change, while the wavelet energy value of vs and the sample entropy have no significant change. Therefore, EEG wavelet energy can effectively evaluate the effectiveness of different acoustic stimuli. But sample entropy is not suitable for evaluating the validity of sound stimulation. (4) the classification of conscious state: based on the energy value of 8-conductance wavelet under self-naming stimulus and music stimulus, the K-harmonic mean clustering method is used in this paper. A total of 33 patients with consciousness disorder were judged by the state of consciousness, and the correct rate of judgment was 78g.
【學位授予單位】：杭州電子科技大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R749.1;TN911.7

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