居家心肺復健監測之行動式照護平台

Abstract

根據統計，心血管疾病是全球近年來造成死亡的主要原因，而對於已罹患心臟病的病人，包括心血管疾病病人、接受心臟手術的術後病人、甚至心臟移植的病人，接受心臟復健運動訓練後對於疾病症狀、生活品質、心肺功能都能有正面的效果。然而，心臟病患實際參與心臟復健運動訓練的比率卻低於三分之一，主要原因是提供復健服務的醫療機構不足、或距離醫院太遠、或時間無法配合。居家復健被視為是一個可行的替代方案，而居家做心肺復健運動訓練，最大的問題在於無法正確評估運動訓練強度、訓練量的控制和維持、運動訓練時安全的控制以及病人遵從醫囑性和配合度的維持。 在本篇論文中，提出一套可移動居家心肺復健監測系統，利用心電訊號擷取裝置透過藍芽傳輸到手機，做即時的分析及監看，除了心跳頻率以外，加入了復健訓練中重要的呼吸頻率的分析，這些資訊也透過實際在醫院進行的實驗，與醫院儀器做相關係數的比對，結果心跳頻率高達98%，呼吸頻率82%。而考量到居家訓練時的安全控制，此系統更加入了心律不整、心跳過快、心跳過慢等的心臟疾病偵測，並整合後端遠距醫療保健平台，達到完整並有效的居家心肺復健監測系統。

Cardiovascular diseases are the most popular causes of death in the world recently. It is well know that doing the cardiac rehabilitation program treatment has positive effects on disease symptoms, quality of life, cardiopulmonary capability and reduction of mortality for the heart disease patients, such as cardiovascular patients, postoperative patients of cardiac surgery, heart failure patients and even the patients who received heart transplant. However, only a small part of heart diseases patients attends and does the exercise regularly. The main reasons of low participation rate are insufficient of medical institutions with rehabilitation treatment service, time constraints and distance from rehabilitation treatment centers. Therefore, a novel cardiac rehabilitation program is needed, especially for the home-based applications. In this study, home-based cardiac rehabilitation programs are designed as a feasible alternative to avoid various barriers related to care centre based programs. Indeed, there are still have drawbacks of current home-based cardiac rehabilitation program models such as, patients are unable to estimate exercise strength accurately, control and maintain the volume of training, safety control of exercise training, and preserve patients’ cooperation and make them follow doctor’s advice. The proposed system is built on mobile phone and receiving electrocardiograph (ECG) signal via a wireless ECG holter. Apart from heart rate (HR) monitor, an ECG derived Respiration (EDR) technique is also included to provide respiration rate (RR) which are the most important parameters during exercise. Clinical test of 16 subjects affording Bruce Task (treadmill), correlation between this system and commercial product (Custo-Med) is up to 98% in HR and 82% in RR. The prevention of sudden heart attack, an arrhythmia detection expert system and healthcare server at the backend are also integrated to this system for comprehensive cardio-pulmonary monitoring whenever and wherever doing the exercise. In word, the proposed system is reliable for the home-based cardiac rehabilitation.