Vital Signs Monitoring of Patients in a Hemodialysis Center Using Wireless Sensor Networks

透析中低血壓(intradialytic hypotension, IDH)是透析治療中最常見的併發症，其發生的頻率大約有10-50%，老年人、糖尿病及心血管透析病患有更高的發生率，其會產生噁心、嘔吐及焦慮等症狀，嚴重甚至會出現休克和死亡的意外。加上血液透析中心護理人員因忙碌或交班，對病房病患生理監控易被臨床工作中斷，或因監測頻率不同、一人照顧多床病患，而影響醫療品質，因此，本研究整合無線感測器網路(Wireless Sensor Network, WSN)、全球行動通信系統(Global System for Mobile Communications, GSM)和數據資料庫，建立一個透析中心生理數據的自動化監測系統，將無線監測技術應用於病患透析中低血壓的產生，並且透過緊急通報系統，讓家屬或是照護人員即時得知透析中低血壓的發生，進而提供更即時的照護。 本系統適用範圍為醫院內血液透析中心的固定空間，系統架構主要分成兩大區塊，前端無線網路以及後端資訊處理主控平臺。在血液透析模擬實驗當中，我們模擬一固定空間裡的血液透析狀況，由六位受測者接受生理值監測，訂定時間區間為二小時連續測量，實驗結果顯示，生理值資料平均傳輸成功率為94.84%，生理值信度取樣分析結果顯示，收縮壓平均信度為1，舒張壓平均信度為0.89，而心搏率平均信度為0.94。實驗結果討論，生理值資料遺失率源於空間障礙物阻礙以及單向傳輸過程的資料碰撞。Intradialytic hypotension (IDH) is a much common complication during a hemodialysis. The prevalence of IDH is about 10-50%. Elderly people, patients with diabetes, and cardiovascular dialysis patients have the highest rate of inci-dences. IDH may lead to nausea, vomiting, or anxiety. In some severe cases, there will be accident like shock and death. Moreover, patients’ physical monitoring is easily interrupted, and medical quality is often compromised, as nurses in a hemodialysis center joggle many tasks at the time. Therefore, the purpose of this paper is to integrate the technologies of wireless sensor networks (WSN) technologies, global systems for mobile communications (GSMs), and a MySQL database to construct an automatic monitoring system to collect physical data during hemodialysis. And an alert can be immediately sent to family members and nurses if IDH occurs. We then apply this wireless monitoring technology to the patients with IDH. This system is applied to an indoor space. The system framework includes two parts: the wireless networks and the controlling platform. During hemodialysis simulations, the average success ratio of physical data transmitting is 94.84%, the average reliability of systolic pressure is 1, of diastolic pressure is 0.89, and of pulse is 0.94, where the testing cases are collected from 6 persons, and the time interval is 2 hours. The loss ratio of physical data results from space constraints and data collision.誌謝......................................................i要.....................................................iibstract................................................iii錄.....................................................iv目錄.................................................viii目錄....................................................x一章 前言..............................................1.1 研究背景..............................................1.2 研究動機及目的........................................2二章 文獻探討..........................................3.1 腎臟透析..............................................3.1.1 慢性腎衰竭..........................................3.1.2 透析原理............................................3.1.3 血液透析............................................3.1.4 腹膜透析............................................4.1.5 透析中低血壓........................................4.2 無線傳輸技術發展......................................5.2.1 無線感測器網路......................................6.2.2 無線感測器網路架構及特點...........................12.2.3 無線通訊技術介紹...................................13.2.4 GSM無線通訊技術....................................17.3 WSN應用的可行性......................................22.3.1 遠距醫療照護.......................................22.3.1.1 社區式遠距照護...................................22.3.1.2 居家式遠距照護...................................23.3.1.3 機構式遠距照護...................................23.3.1.4 透析問題與遠距醫療照護...........................23.3.2 無線感測器網路應用於遠距醫療照護...................24.3.3 無線感測器傳輸效能相關研究.........................26三章 研究方法.........................................27.1 實驗材料與實驗設計...................................28.1.1 無線生理值感測硬體.................................28.1.2 主控平臺資料處理機制...............................30.2 系統效能分析與驗證方法...............................32.2.1 硬體穩定度分析.....................................34.2.1.1 無線感測器與個人電腦閘道器傳輸效能驗證方法.......34.2.1.2 無線感測器與簡訊處理伺服器傳輸效能驗證方法.......34.2.2 系統軟體分析.......................................35.2.2.1 個人電腦閘道器通報系統驗證方法...................35.2.2.2 資料庫伺服器與網頁瀏覽效能驗證方法...............36.2.3 全系統信度分析方法.................................36.3 主控平臺端監測程式...................................38.3.1 PC-based gateway主控平臺...........................39.3.1.1 生理值監測模式設定...............................46.3.1.2 量測ERROR情況處理................................47.3.1.3 人性化簡易瀏覽生理值資訊界面.....................48.3.2 伺服器主控平臺.....................................49.3.3 資料庫系統查詢.....................................50.3.4 居家生理值監測以及警戒值通知系統...................53四章 結果與討論.......................................55.1 無線感測器與個人電腦閘道器傳輸效能驗證...............55.1.1 單具生理值監測模組與個人電腦閘道器溝通.............55.1.2 五具生理值監測模組與個人電腦閘道器溝通.............56.2 無線感測器與簡訊處理伺服器傳輸效能驗證...............57.2.1 單人於固定空間透析中生理值監測模擬.................57.2.2 六人於固定空間透析中生理值監測模擬.................57.3 個人電腦閘道器通報系統驗證...........................58.4 資料庫伺服器與網頁瀏覽效能驗證.......................59.5 全系統信度分析.......................................61五章 結論與未來工作...................................63考文獻.................................................65錄一...................................................71錄二...................................................72錄三...................................................74錄四...................................................75錄五...................................................7