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http://fedetd.mis.nsysu.edu.tw/FED-db/cgi-bin/FED-search/view_etd?identifier=oai:www.etd.library.tcu.edu.tw:etd-0729105-181132-48&index_word=
| 論文英文名稱 | Effect of Gender and Development on Fetal Heart Rate Variability --- Spectral Analysis by Doppler Ultrasound |
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| 論文中文名稱 | 性別及成長過程胎兒心率變異性的變化－胎心音頻譜分析 |
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| 作者中文姓名 | 劉榮啟 |
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| 英文關鍵字 | different genderfetal developmentfetal autonomic statefetal heart rateDoppler ultrasoundpower spectral analysisfetal heart rate variabilityFetal heart sound |
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| 中文關鍵字 | 性別差異胎兒發育胎兒自主神經活性胎兒心率都卜勒超音波頻譜分析胎兒心率變異性胎心音 |
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| 英文摘要 | Fetal heart rate variability (FHRV) is the most important parameter of fetal well-being. To date, visual inspection is a more popular method to analyze FHRV, but it is relatively subjective and qualitative. To develop a non-invasive and quantitative method to detect the fetal heart rate, we recorded the fetal heart sounds of the normal pregnancy women who visiting the OPD of Yu Li Veterans Hospital for prenatal care. Fetal heart sounds were recorded for 2.5 minutes with supine position in a quite room. Fetal heart sounds were detected from a mini-microphone in conjunction with abdominal ultrasound, ultrasound fetoscope, and fetal monitor. The off-line data was analyzed by self-designed program software with fast Fourier transform and spectral analysis. Frequency domain analysis of beat-to-beat intervals including very low frequency power (VLF, 0.003-0.04 Hz), low frequency power (LF, 0.04-0.15 Hz), high frequency power (HF, 0.15-0.4 Hz) and the ratio of LF to HF (LF/HF) were performed. Ninety-four recording trials from 76 pregnancy women were recorded in this study and 48 were selected to be quantitatively analyzed. Three groups were defined: 1st trimester (gestational age of 9-14 week, N = 5); 2nd trimester (gestational age of 15-28 weeks, N = 18) and 3rd trimester (gestational age of 29-41 weeks, N = 25). The results showed that fetal heart rate was decreased by gestational age significantly. VLF, LF, HF and TP were increased significantly and LF/HF decreased in the 3rd trimester. Heart rate of male fetus was significantly higher than female only in the 3rd trimester. We concluded that Power spectral analysis of FHRV is a non-invasive, convenient method and spectral analysis of fetal heart rate variability by Doppler ultrasound is feasible. The heart rate of male fetus was higher than female significantly in the third trimester. It seems that the parasympathetic activity of fetal autonomic state was increased significantly in the 3rd trimester. And the decrease of LF/HF may be the indicator of maturity of autonomic nervous system in fetal development. |
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| 中文摘要 | 胎兒心率變異性是評估胎兒健康狀況很重要的指標。過去都是以目測法來測量胎兒心率變異性，常常會有不準確和主觀的影響。已知胎兒心率會隨著懷孕週數增加而變慢，這和自主神經發育及成熟有關。於成人的研究中已知心率變異性的頻譜分析證實可以反應自主神經活性，若能經由胎兒心率變異性測出自主神經活性，將可以對胎兒的自主神經發育有更近一步了解。本論文主要是利用原來診間所使用的工具，發展一個非侵襲性、定量性的胎兒心率變異性測量方法及評估胎兒性別及發育階段對心率變異性的影響。研究對象來源為玉里榮民醫院婦產科產檢的懷孕婦女，胎兒懷孕週齡分佈為9-41週。實驗方法是在一安靜環境下，孕婦保持仰臥姿勢，測量胎心音方式如同一般產檢，分別以腹部超音波、胎心筒或胎兒監視器的檢查外加自製的迷你麥克風、IBM相容電腦，收錄2.5分鐘的胎兒心音。將取得的超音波心音資料以郭博昭教授所設計的軟體進行離線分析，包括計算心跳間距及心率頻譜分析的測量。受測者共有76人，一共完成了94人次在不同懷孕週數的胎心音記錄。排除訊號較差者，留下48人次納入分析。受測結果共分為3組：懷孕第一期 (9-14週) 共5人次、懷孕第二期 (15-28週) 共18人次、懷孕第三期 (29-41週) 共25人次。心率頻譜分析值包括總功率 (total power) 、超低頻功率 (VLF, 0.003-0.04 Hz) 、低頻功率 (LF, 0.04-0.15 Hz) 、高頻功率 (HF, 0.15-0.4 Hz) 、低頻與高頻比值 (LF/HF) 。實驗結果顯示胎兒未分期即可見到心率隨著懷孕週數顯著下降，心率變異之TP、VLF、LF、HF均隨著懷孕週數顯著增加。進一步分成3期則看到胎兒心率在懷孕第二期、第三期都有顯著下降。在懷孕第三期心率變異性之VLF、 LF、 HF及TP均顯著增加，比第二期高。而LF/HF則顯著下降，比第二期低。其中VLF同時高於第一期及第二期。在性別差異方面男性胎兒心率比較快，心率變異性之VLF、 LF、 HF及TP則女性有較高的趨勢，但不具統計意義。唯男性胎兒在懷孕第三期心率明顯比女性快。由以上的結果我們的結論是利用胎心音頻譜分析來測量胎兒心率變異性是一個方便、非侵襲性而且可行的方法。胎兒心率變異性隨著懷孕週齡增加而明顯增加，在懷孕第三期特別明顯。其中TP、VLF、LF及HF明顯增加，LF/HF 明顯下降。而且在懷孕第三期男性的心率明顯比女性快。同時可能顯示胎兒自主神經系統之副交感神經對心率的調控在懷孕第三期明顯增加而LF/HF的顯著下降可能是代表自主神經成熟的指標。 |
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| 統計 | 本論文已被瀏覽 43 次，造訪原文 6 次 |
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| 畢業學校 | 慈濟大學 |
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| 出版單位 | 慈濟大學 |
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| 論文目次 | 中文摘要………………………………..…………………………………I 英文摘要………………………………..……………………….………III 目錄………………………………………..……………………..V 研究背景………………………………..………………………..…………1 胎兒心率變異性對臨床的重要性…………………..………………….…1 胎兒自主神經對心臟調控的發育……………………..……………..….3 性別對心率變異性的影響………………………………………………..6 年齡對心率變異性的影響…………………………………………….…8 胎兒心率的調控…………….……………………………………………9 胎兒心率變異性與自主神經活性………………………………………13 成人心率變異性頻譜分析及其應用……………………………………..14 胎兒心率變異性的研究和應用現況….………………………………....17 目前胎兒心率變異性的測量方法………………………………………20 研究動機與目的……………………………………………………….22 研究動機………………………………………………………………….22 研究目的…………………………………………………………………24 重要性…………………………………………………………………...24 研究材料與方法…………………………………………………25 研究對象及實驗分組……………………………………………………25 實驗儀器……………………………………………………..………….25 測量胎心音的工具……………………………………………………25 錄音工具…………………………………………………..……….…25 分析工具……………………………………………….……………..26 實驗步驟…………………………………………………………………26 胎心音記錄……………………………………………….……...………26 頻譜分析………………………….…………………….…………..……27 統計分析……………………….…………………………………..….…28 研究結果………………………………………..……………...28 各組基本資料分析…………………………………………….………28 胎心音原始資料及頻譜分析……………….…………………………29 年齡對胎兒心率變異性之影響………………………………....………30 性別對胎兒心率變異性之影響……………………………….………30 討論………………………………………..…………………….31 性別對胎兒心率變異性之影響………………………..…….….………31 年齡對胎兒心率變異性之影響…………………………..…..……… 32 胎兒心率變異性與自主神經之相關……………………………………34 用胎心音偵測心跳間距當做頻譜分析的資料來源：正確性、可行性….36 胎兒心率變異性的頻譜分析所面臨的問題………..………………….37 胎兒心率變異性的頻譜分析和成人、新生兒的比較………………….38 將來的臨床應用…………………………………………….…………..39 本論文之貢獻……………………………………………………………39 本論文之缺點……………………………………………………………40 結論………………………………………………………..…….43 附表…………………………………………………………….44 附圖…………………………………………………………….47 附件…………………………………………………………….55 參考文獻……………………………………………………….58 |
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British Journal of Obstetrics & Gynecology, 106, 664-671. Yien, H.W., Hseu, S.S., Lee, L.C., Kuo, T.B.J., Lee, T.Y. & Chan, S.H.H. (1997). Spectral analysis of systemic arterial pressure and heart rate signals as a prognostic tool for the prediction of patient outcome in the intensive care unit. Critical Care Medicine, 25, 258-266. |
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| 口試委員 | 楊靜修 - 指導教授
郭博昭 - 指導教授
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| 核准日期 | 2005-07-29 |
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| 類型 | Electronic Thesis or Dissertation |
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| 格式 | application/pdf |
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| 全文資料 | 校內外皆可取得 |
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| 詳細資料暨全文 | http://www.etd.library.tcu.edu.tw/ETD-db/ETD-search-c/view_etd?URN=etd-0729105-181132-48 |
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| 語言 | Chi |
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| 權限 | Copyright information available at source archive--Tzu Chi University |
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