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  5. 利用血流動力學及自律神經檢查提早發現迷走神經性昏厥
 
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利用血流動力學及自律神經檢查提早發現迷走神經性昏厥

Other Title
Early Detection of Vasovagal Syncope in Tilt-up Test with Hemodynamic and Autonomic Study
Type
thesis
Date Issued
2011-06-23
Author(s)
陳俊安
Advisor
邱泓文
Subjects
系所名稱:醫學資訊研究所
Description
學位別:碩士
語文別:中文
指導教授:邱泓文
共同指導教授:
口試委員:朱信;許明輝
中文關鍵字:迷走神經性昏厥;邏輯式迴歸;類神經網路
Abstract
對於昏厥之病患需先詳細詢問病史是否有誘發因子,且排除心肌梗塞或心律不整,並且需與眩暈、癲癇及短暫性腻缺血區別,並安排傾斜床檢查以確定診斷。傾斜床檢查是評估反覆性原因不明昏厥之最佳工具。傾斜床檢查流程頇耗時長達45分鐘,利用延長傾斜床檢查之時間以增加診斷率,亦可使用血管擴張藥物以增加陽性率及縮短時間。但使用藥物檢查會使其專一性下降,增加假陽性機會。
因為迷走神經性昏厥病患之複雜性、多因子、異質性,故利用非藥物傾斜床檢查評估迷走神經性昏厥及解釋其生理病理發現。經由陽性病患及受詴正常者的血流動力學及自律神經參數了解迷走神經昏厥之生理變化分析其差異以了解其致病機轉。結果發現,迷走神經性昏厥病患的體重、身體質量係數、帄躺之帄均血壓較低;傾斜測詴下昏厥前期時,心跳、心率變異低頻/高頻比率上升、感壓反射敏感度下降較明顯、周邊血管阻力係數較低。於昏厥前其心跳加快、心率變異低頻/高頻比率上升代表交感神經活性增強,而較低的周邊血管阻力係數代表後負荷(血管壁交感神經活性)較低,昏厥時心跳減慢代表副交感神經活性增強。
並利用基本資料、身體組成、帄躺及傾斜早期血流動力學及自律神經參數,運用邏輯式回歸及類神經網路分析建立一模組早期預測其發生,發展一種早期偵測會在檢查時發生昏厥之病患,以免發生嚴重之意外。利用身體質量指數、帄躺時心跳、傾斜3分鐘心輸出係數、傾斜3分鐘左心做功係數、傾斜3分鐘帄均血壓訓練之類神經網路,訓練組敏感度為92%;專一度為95%,正確率為93.75%;驗證組正確率為100%。ROC闕值為0.517,ROC曲線下面積為0.979,整體敏感度為93%;專一度為96%,正確率為95.5%,模組狀況佳可提早辨識發生的病患。
URI
https://203.71.86.71/handle/123456789/13610

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