| 摘要: | 呼吸器是加護病房中很重要的設備，除了幫助呼吸衰竭的病人呼吸，也提供病人得到需要的通氣量以支持病人的生命。本論文提出計算病人最理想的每分鐘通氣量為主軸，設計了完整的監控系統幫助醫護人員即時掌握呼吸器病人的通氣量狀況。呼吸器的使用模式有很多種，有的模式是控制呼吸的容積，有的是控制呼吸的次數，本論文參考了吳清平醫師團隊於2010年發表的論文，在同時控制呼吸次數與容積的新型順應性支持換氣(Adaptive Support Ventilation; ASV) 模式下，來測量出病人最佳的每分鐘通氣量百分比(Optimal Minute Volume; OMV%)，以OMV%當作判斷病人呼吸狀況的新指標。在ASV模式下測量OMV%的過程耗時且需要醫護人員不時地調整呼吸器旋鈕，不僅增加醫療人員的工作量，同時也降低醫療效率，本論文的主要設計是將測量OMV%的過程自動化，且利用模擬肺產生自發性呼吸的架構來實證，進而得知可依臨床的需求，每天定時的自動測量OMV%，並將測量的結果顯示在監控系統的介面上供醫護人員參考。另外，本論文提出的系統架構是利用ASV模式的計算策略，將Otis曲線創新設計在監控系統的介面上，以計算呈現病人所需的每分鐘通氣量、每分鐘呼吸次數、潮氣容積以及安全範圍限制與警報，然而此監視系統是創新獨立於呼吸器外，使得使用呼吸器的病人，都能依此找出病人的最佳每分鐘通氣量目標，最後，加上數位化的病歷系統，發展出完整的病人最佳每分鐘通氣量監控系統。;Nowadays, mechanical ventilations play an important role in the intensive care unit (ICU). It not only help patients with respiratory failure breathe normally, but also maintain the basic respiratory volume which the patients need to let them survive. This study propose a method for calculating the ideal minute volume, and design a complete monitoring system to help paramedics know the patients’ condition immediately. When medical workers use mechanical ventilations, there are many kinds of modes they can choose. Some modes can only control the volume, and some other modes can only control the frequency. By referring to the paper proposed by the team of doctor Wu in 2010, this study survey the Optimal Minute Volume (OMV%) in the Adaptive Support Ventilation(ASV) mode, which is a novel mode that can control both volume and frequency. Besides, this study take OMV% as a new index of patients’ respiratory condition. Since the process of surveying OMV% is time-consuming and need paramedics to tune the knob frequently, it increase the burden of paramedics as well as decrease the medical efficiency. Therefore, this study design a system to become the process of surveying OMV% automatically. We use lung model to produce spontaneous breathe to do the experiment. After that, the system allows the mechanical ventilation to automatically survey OMV% at fixed time every day and present the result at human computer interface for paramedics. Moreover, this system uses the computational strategy in ASV mode to calculate the target minute volume, target tidal volume, target respiratory rate and safety range. These information are shown on the monitoring interface. However, this monitoring system is independent of a ventilator. It can help patient find optimal minute volume. In the end, this study combine digital medical record with this monitoring system to develop a complete optimal respiratory volume monitoring system.
Keyword: Optimal Minute Volume, Mechanical Ventilation Monitoring System, Minute Volume Monitoring |
