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引文資料
題名:
迷走神經性昏厥之早期診斷--利用類神經網路建立輔助診斷預測模型系統
書刊名:
醫療資訊雜誌
作者:
紀彣宙
/
邱泓文
/
陳俊安
作者(外文):
Chi, Wen-chou
/
Chiu, Hung-wen
/
Cheng, Chun-an
出版日期:
2011
卷期:
20:4
頁次:
頁13-24
主題關鍵詞:
人工智慧
;
迷走神徑昏厥
;
類神經網路
;
傾斜床測試
;
決策支援系統
;
Artificial intelligence
;
Vasovagal syncope
;
Artificial neural network
;
Tilt-table testing
;
Decision support system
原始連結:
連回原系統網址
相關次數:
被引用次數:期刊(0) 博士論文(0) 專書(0) 專書論文(0)
排除自我引用:0
共同引用:0
點閱:24
昏厥的發生易造成意外及跌倒,危害患者之安全甚鉅,但昏厥之成因相當複雜,因此診斷有其難度,而預測就更加困難,傾斜床檢查是評估反覆性原因不明昏厥之最佳工具。一部分的傾斜床檢查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。本研究利用個案非藥物傾斜床檢查之血液動力學資料以及身體質量資料,蒐集與昏厥相關之因子,並將之透過類神經網路之方式建立昏厥之預測模型,提供臨床醫師作為決策之參考,協助診斷及預防暈厥所造成之傷害。研究共蒐集60個個案,30個為神經性昏厥確診個案,另30個為傾斜床測試陰性反應個案,利用非藥物傾斜床檢查評估迷走神經性昏厥,蒐集其性別、年齡、身體組成、平躺、檢查3分鐘以及傾斜檢查結束前之血液動力資料。結果發現,迷走神經性昏厥病患的體重、身體質量係數、平均血壓較低;傾斜測試下昏厥前期時,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。透過基本資料、平躺及傾斜早期血流動力學及自律神經參數,運用邏輯式迴歸及類神經網路分析建立之預測模組其參數包含身體質量指數、平躺時心跳、傾斜3分鐘心輸出係數、傾斜3分鐘左心做功係數、傾斜3分鐘平均血壓。該模組整體敏感度(Sensitivity)為93%;專一度為(Specificity)96%,正確率(Accuracy)為95.5%,模組狀況佳可提早辨識發生的病患。
以文找文
The occurrence of syncope could easily lead to accidents and falls, which endangering the safety of patients enormously. Early diagnosis helps to reduce the harm caused by the disease. However, the causes of syncope are very complex, and its diagnosis is difficult. Tilting-table test is the appropriate way to assess the recurrent unexplained syncope. Some of the Tilting-table test using vasodilator agent to increase the positive rate and shorten the time, but pharmacological challenge test will decrease the specificity and increase opportunities for false positive. In this study, hemodynamic and body content data collected from cases of non-pharmacological Tilting-table, were analyzed to extract factors which are related to vasovagal syncope. These factors were applied in the neural networks to build up a model which can predict vasovagal syncope. Among total collection of 60 cases, 30 of vasovagal syncope confirmed cases and another 30 to Tilting-table test were the negative cases. The study use of non- pharmacological Tilting-table test collect the hemodynamic data from cases when they were supine, 3 minutes after tilt up test and prior to end of tilt up test. The results showed that patients with vasovagal syncope have lower body weight, body mass index and the mean blood pressure during supine position. During tilt test, there were higher heart rate variability low frequency / high frequency ratio (HRV LF/HF), lower baroreflex sensitivity (BRS) and total peripheral resistance index (TPRI) than negative group during presyncopal period. The body mass index, supine heart rate, Cardiac Index(CI) while tilt up 3 minutes , Left Ventricular Work Index(LVWI) while tilt up 3 minutes, and the mean blood pressure (MBP) while tilt up 3 minutes were selected from logistic regression analysis, which are related factors of vasovagal syncope. The model using those factors build by ANN show that the training group's sensitivity was 92%; specificity was 95% and accuracy was 93.75%.; the validation group have 100% accuracy, ROC threshold is 0.517, ROC area under the curve is 0.979; the overall sensitivity of 93%; specificity of 96%, accuracy was 95.5%. The model has good performance to predict vasovagal syncope.
以文找文
期刊論文
1.
Soteriades, E. S.、Evans, J. C.、Larson, M. G.、Chen, M. H.、Chen, L.、Benjamin, E. J.、Levy, D.(2002)。Incidence and prognosis of syncope。N Engl J Med.,347(12),878-885。
2.
Olde Nordkamp, L. R. A.、van Dijk, N.、Ganzeboom, K. S.、Reitsma, J. B.、Luitse, J. S.、Dekker, L. R.、Shen, W. K.(2009)。Syncope prevalence in the ED compared to general practice and population: a strong selection process。Am J Emerg Med.,27(3),271-279。
3.
Sarasin, F. P.、Louis-Simonet, M.、Carballo, D.(2001)。Prospective evaluation of patients with syncope: a population-based study。Am J of Med.,111(3),177-184。
4.
Chen-Scarabelli, C.、Scarabelli, T. M.(2004)。Neurocar diogenic syncope。BMJ,329(7461),336-341。
5.
Virag, N.、Sutton, R.、Vetter, R.、Markowitz, T.(2007)。Erickson M Prediction of vasovagal syncope from heart rate and blood pressure trend and variability: Experience in 1,155 patients。Heart Rhythm,4(11),1377-1382。
6.
Garg, A. X.、Adhikari, N. K.、McDonald, H.(2005)。Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review。JAMA,293(10),1223-1238。
7.
Clayton, P. D.(1995)。Hripczak G Decision support in healthcare。Int J Biomed Comput.,39,59-66。
8.
Mallat, Z.、Vicaut, E.、Sangare, A.、Verschueren, J.、Fontaine, G.、Frank, R.(1997)。Prediction of Head-Up Tilt Test Result by Analysis of Early Heart Rate Variations。Circulation,96(2),581-584。
9.
Pitzalis, M.、Massari, F.、Guida, P.、Iacoviello, M.、Mastropasqua F.、Rizzon, B.、Forleo, C.(2002)。Shortened head-up tilting test guided by systolic pressure reductions in neurocardiogenic syncope。Circulation,105(2),146-148。
10.
Turk, U.、Alioglu, E.、Kirilmaz, B.、Duygu, H.、Tuzun, N.、Tengiz, I.、Zoghi, M.(2010)。Prediction of Head-Up Tilt Test Result: Is it Possible?。PACE,33(2),153-158。
11.
Fortrat, J. O.、Schang, D.、Bellard, E.、Victor, J.、Leflheriotis, G.(2007)。Cardiovascular variables do not predict head-up tilt test outcome better than body composition。Clin Auton Res.,17(4),206-210。
12.
Kapoor, W. N.、Brent, N.(1992)。Evaluation of upright tilt testing with isoproterenol。Ann Intern Med.,116(5),358-363。
13.
Hausenloy, D. J.、Arhi, C.、Chandra, N.、Manus, A. F.、Meyer, A.、Sutton, R.(2009)。Blood pressure oscillations during tilt testing as a predictive marker of vasovagal syncope。Europace.,11(12),1696-1701。
14.
Meyer, C.、Morren, G.、Muehlsteffi, J.、Heiss, C.、Lauer, T.、Schauerte, P.、Rassaf, T.(201109)。Predicting neurally mediated syncope based on pulse arrival time: algorithm development and preliminary results。J Cardiovasc Electrophysiol,22,1042-1048。
15.
Gimeno-Blanesl, F. J.、Rojo-Álvarez, J. L.、Caamaño, A. J.、Flores-Yepes, J. A.、García-Alberola, A.(2011)。On the feasibility of tilt test outcome early prediction using ECG and pressure parameters。EURASDP Journal on Advances in Signal Processing,2011(7),33。
16.
Bizios, A. S.、Sheldon, R. S.(2008)。Vasovagl syncope: state or trait?。Curr Opin Cardiol.,24(1),68-73。
17.
Beacher, F. D.、Gray, M. A.、Mathias, C. J.、Critchley, H. D.(2009)。Vulnerability to simple faints is predicted by regional differences in brain anatomy。Neuroimage,47(3),937-945。
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