本文選題：全身麻醉 + 傷害感受監(jiān)測��； 參考：《浙江大學》2012年博士論文

【摘要】：全身麻醉中傷害感受的監(jiān)測具有重要的臨床意義,近來研究者基于光電容積脈搏波(PPG)的幅度建立了傷害感受的監(jiān)測指標,比如外科應激指數(shù)SSI和傷害感受響應指標RN。然而,PPG的幅度易受測量條件的影響,且所采用的標準化方法理論適用性不高。 因此,本論文的研究目的是從PPG的形態(tài)方面提出參數(shù),并建立了一個基于其形態(tài)的傷害感受的監(jiān)測指數(shù)SPMI。本論文的主要內容和創(chuàng)新成果如下： (1)PPG特征點的檢測算法 采用局部查找方法,結合一階、二階導數(shù)和邏輯判斷條件建立了PPG的特征點檢測算法。算法評估結果表明,在含有干擾信號的情況下,此算法的靈敏度和陽性預測率可達95%以上,該檢測算法可靠。 (2)PPG幅度和形態(tài)的特異度和靈敏度研究 根據(jù)彈性腔理論,解析推導出了PPG的5個形態(tài)參數(shù),QRC、ARD、ARA、ART和PBI。另外也研究了PPG的幅度參數(shù)PPGA。 以PPGA和ART為例對比了血流灌注、測量位置和測量體位變化時PPG幅度和形態(tài)的相對變化率,統(tǒng)計分析表明ART的相對變化率小于PPGA,表明PPG形態(tài)的特異度更高。 采用氣管插管為傷害性刺激,并用不同的抗傷害感受藥物濃度產(chǎn)生不同程度的傷害感受,以預測概率為指標評估了所有參數(shù)的靈敏度。結果表明表征氣管插管時,靈敏度次序為PBIARTPPGAARDARAQRC,形態(tài)參數(shù)和幅度參數(shù)不相上下。表征不同程度的傷害感受時,靈敏度次序PBI ARTARAARDQRPPGA,形態(tài)參數(shù)均高于幅度參數(shù)。 (3)基于PPG形態(tài)的外科指數(shù)SPMI的建立 采用多參數(shù)結合方法,經(jīng)多元線性回歸得到SPMI=30-43×PBI+45×ART。性能評估表明,插管前SPMI和瑞芬太尼藥物濃度的Spearman相關系數(shù)為-0.30,插管時為-0.52,均高于SSI的-0.21。SPMI預測CSSA的預測概率為0.819,高于文獻所報道的RN的0.78。 本論文基于PPG的形態(tài)特征,建立了一個抗傷害感受的指數(shù)SPMI,其性能優(yōu)于基于PPG幅度的其它指數(shù),有利于獲得更好的麻醉效果。
[Abstract]:The monitoring of injury feeling in general anesthesia has important clinical significance . Recently , researchers have established monitoring indexes of injury perception based on the amplitude of photoelectric volume pulse wave ( PPG ) , such as surgical stress index ( SSI ) and damage feeling response indicator RN . However , the amplitude of PPG is easily influenced by the measurement conditions , and the applicability of the standardized method is not high .

Therefore , the purpose of this paper is to propose parameters from the aspect of PPG and to establish a monitoring index SPMI based on its morphology . The main contents and innovations of this paper are as follows :

( 1 ) Detection algorithm of PPG feature points

The feature point detection algorithm of PPG is established by means of local searching method combining first order , second order derivative and logic judgment condition . The results show that the sensitivity and positive predictive rate of this algorithm can reach more than 95 % when the interference signal is contained , and the detection algorithm is reliable .

( 2 ) Specific Degree and Sensitivity of PPG Amplitude and Morphology

Five morphological parameters , QRC , ARD , ARA , ART and PBI of PPG were derived based on the theory of elastic cavity . The amplitude parameters PPGA of PPG were also studied .

The relative rates of change of PPG amplitude and morphology were compared with PPGA and ART as examples . The statistical analysis showed that the relative change rate of PPG was less than PPGA , indicating that the specific degree of PPG was higher .

The results showed that the sensitivity order was PBIARTPPGAARDARAQRC . The sensitivity order PBI ARTARAARDQRPPGA and the morphological parameters were higher than the amplitude parameters when the tracheal intubation was characterized by PBIARTPPGAARDARAQRC , morphological parameters and amplitude parameters .

( 3 ) Establishment of SPMI for Surgical Index Based on PPG Morphology

A multivariate linear regression was used to obtain SPMI = 30 - 43 脳 PBI + 45 脳 ART .

Based on the morphological characteristics of PPG , this paper establishes an index SPMI with anti - injury feeling , which is superior to other indexes based on PPG amplitude , which is beneficial to obtaining better anesthetic effect .

【學位授予單位】：浙江大學
【學位級別】：博士
【學位授予年份】：2012
【分類號】：R318

【參考文獻】

相關期刊論文 前1條

1 羅志昌,程桂馨,吳崢嶸,費開明,叢克家;人體脈搏波波形參數(shù)與生理參數(shù)間關系的理論和實驗研究[J];北京工業(yè)大學學報;1988年02期

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本文編號：1765297