基于直肠感知功能重建的人工括约肌系统研究

发布时间：2018-12-15 02:20

【摘要】：大便失禁指肛门括约肌失去对粪便及气体排出的控制能力，是临床上常见的病症。它容易造成多种并发症，尤其在老年患者、危重患者及瘫痪卧床患者中发病率居高不下，不仅给患者带来极大痛苦，而且也给护理工作带来诸多困难。随着人口老龄化趋势的发展，大便失禁已成为医疗、护理亟需解决的问题，相关治疗手段与科学技术的发展对提高患者生命质量和推动社会文明进步具有重要的现实意义。治疗大便失禁的传统方法很多，但是都存在一定的缺陷，甚至可能产生严重的并发症。随着人们对健康和生命质量的要求不断提高，传统的治疗方法已经不能满足患者的需求，人工肛门括约肌为大便失禁的治疗开辟了一条新途径；国内外学者已经针对人工肛门括约肌的仿生结构、控制方式、能量供给等方面开展了大量研究工作。但是，当前人工肛门括约肌领域涉及的直肠感知功能重建的研究尚无显著进展，因此围绕目前人工肛门括约肌研究无法重建患者直肠感知功能这一关键问题，进行相关技术方法的深入探索和研究，并充分发挥现代信息处理技术、材料科学技术、生物医学技术等多学科交叉优势，研究一种完全适合植入人体的人工肛门括约肌势在必行。本文基于国家自然科学基金科研项目的研究背景，以人工肛门括约肌为研究对象，着重进行直肠感知功能重建的理论方法及相关技术的研究，同时针对特征向量选取和模式识别算法优化的相关方法进行积极探索，并在此基础上构建人工肛门括约肌直肠感知功能重建的实验平台，以验证相关方法技术的可行性和有效性；全文工作可以概括为人工肛门括约肌系统的开发和实现、直肠感知功能重建理论与方法、模拟肠道实验平台构建与验证分析三大部分。所做主要研究工作与贡献如下：（1）介绍人体排便的基本生理常识和人体肛门失禁的概况；阐述了肛门失禁治疗方法和人工肛门括约肌方面的国内外研究现状；分析了目前临床医学上针对肛门失禁的治疗方法及其不足；根据人体生物肛门和结直肠的结构特点，提出基于生物反馈控制的人工肛门括约肌系统构思。（2）人工肛门括约肌系统的仿生学实现。本论文在研究肛门括约肌肌群生理学的基础上，探索运用工程技术重建肛门括约肌理论、方法和排便控制机理，模拟肛门括约肌各肌群的基本功能；提出系统技术方案，分析系统三大技术模块：基于生物反馈控制的人工肛门执行机构、无线通信模块和经皮供能模块；按照模块化和低功耗的要求研究人工肛门括约肌系统的实现结构。（3）直肠压力收缩信号的特征提取算法研究。本文在分析现有特征提取方法及存在的问题基础上，针对直肠收缩信号的非线性、非平稳性，提出了基于小波包分解子空间时域特征及子空间频域特征的的直肠压力特征提取方法。为从原始特征集中找到最有利于分类的最优特征集，以提高分类器的精度和分类准确率，提出了基于Fisher距离的最优小波包基直肠压力特征选择方法，以及基于DB（Davies-Bouldin，DB）指标优化的最优小波包基直肠压力特征选择方法，并基于概率神经网络（Probilistic Neural Network，PNN）模型验证了提出方法的有效性。（4）直肠压力收缩信号的分类算法研究。本文将基于PNN的分类、基于支持向量机的分类应用于直肠收缩信号的分类预测；同时提出了基于粒子群优化算法优化支持向量机参数的直肠收缩信号特征向量分类方法，并在此基础上对采集到的直肠压力特征向量进行了分类预测，对比分析了三种分类预测方法的分类准确率，验证了所提分类方法的有效性和优越性。（5）构建基于生物反馈式人工肛门括约肌实验模型与实验平台，在上述理论与方法的指导下，通过模拟人体肠道环境，获取大量实验数据，验证人工肛门括约肌的基本功能、直肠感知功能重建模型的有效性，，根据评估结果改进和完善人工肛门括约肌系统，为大便失禁患者人工器官的最终临床应用提供理论方法依据与技术基础支持。
[Abstract]:The incontinent of the anus refers to the loss of control ability of the anal sphincter to the discharge of the faecal matter and the gas, which is a common condition in the clinic. It is easy to cause a number of complications, especially in the elderly, critically ill patients and in patients with paralysis, not only to the patient, but also to the care work. With the development of the trend of the aging of the population, the fecal incontinence has become a problem for medical care and nursing, and the related treatment means and the development of science and technology are of great practical significance for improving the quality of life of patients and promoting the progress of the social civilization. Traditional methods for the treatment of fecal incontinence are many, but there are some defects and may even lead to serious complications With the increasing demand of people for health and quality of life, the traditional method of treatment has not met the needs of the patient, and the artificial anal sphincter opens a new way for the treatment of fecal incontinence; and the domestic and foreign scholars have been aiming at the bionic structure of the artificial anal sphincter, and the control prescription A large number of studies have been carried out in terms of formula, energy supply, etc. However, there is no significant progress in the research of the reconstruction of the rectal sensing function involved in the field of artificial anal sphincter. Therefore, the key problem in the study of the rectum-sensing function of the patient can not be reconstructed around the present artificial anal sphincter. To study and give full play to the cross-cutting advantage of modern information processing technology, material science and technology, and biomedical technology, a kind of artificial anal sphincter which is completely suitable for human body is studied. In this paper, based on the research background of the National Natural Science Fund (NSFC) research project, the artificial anal sphincter is used as the research object, and the theoretical method and related techniques for the reconstruction of the rectal sensing function are emphasized. At the same time, the research on the optimization of the feature vector selection and the pattern recognition algorithm is explored, and the experimental platform for the reconstruction of the artificial anal sphincter and the rectal sensing function is constructed, so as to verify the feasibility of the related methods and techniques. Effectiveness: The full-text work can be summarized as the development and realization of the artificial anal sphincter system, the theory and method of the reconstruction of the rectal perception function, the construction and verification of the experimental platform of the simulated intestinal tract. Most of them. The main research work and the tribute The following are the following: (1) introduction of the basic physiological knowledge of the defecation of the human body and the general situation of the anal incontinence of the human body; and the domestic situation of the anal incontinence treatment method and the artificial anal sphincter. The present situation of external research is analyzed. The treatment of anal incontinence in the present clinical medicine and its deficiency are analyzed. According to the characteristics of the biological anus and the structure of the colorectal, the artificial anal is proposed based on biofeedback control. muscular system conception. (2) Artificial anal sphincter system This paper, based on the study of the physiology of the sphincter of the anal sphincter, explored the theory, method and the mechanism of defecation control for the reconstruction of the anal sphincter, and the basic function of the muscle group of the anal sphincter. The system technical scheme and the analysis system were put forward. The three major technical modules of the system: the artificial anal actuator, the wireless communication module and the skin energy supply module based on the biofeedback control; and the artificial anal sphincter is researched according to the requirements of the modularization and the low power consumption. System realization structure. (3) Rectal pressure contraction signal In this paper, based on the analysis of the existing feature extraction methods and the existing problems, the paper presents a method based on the wavelet packet decomposition sub-space time domain and the frequency-domain characteristics of the sub-space for the non-linear and non-stationarity of the rectal contraction signal. In order to improve the accuracy and classification accuracy of the classifier, the optimal wavelet packet-based rectal pressure feature selection method based on Fisher's distance is proposed. The optimal wavelet packet-based rectal pressure feature selection method for s-Bouldin (DB) index optimization and verification based on the probabilistic neural network (PNN) model The effectiveness of the proposed method is presented. (4) Rectal pressure The classification algorithm of the contraction signal is based on the classification of PNN, which is applied to the classification and prediction of the rectal contraction signal based on the classification of the support vector machine, and the rectal charge of the parameter of the support vector machine is optimized based on the particle swarm optimization algorithm. The classification method of the characteristic vector of the contraction signal is carried out on the basis of the classification and prediction of the feature vector of the collected rectal pressure. The classification accuracy of the three classification methods is compared and analyzed, and the extracted score is verified. and (5) constructing a biological feedback type artificial anal sphincter experimental model and an experimental platform, and under the guidance of the theory and the method, a large amount of experimental data is obtained through the simulation of the human intestinal environment, The basic function of the artificial anal sphincter and the effectiveness of the reconstruction model of the rectal sensing function are improved and the artificial anal sphincter system is improved and improved according to the results of the evaluation.
【学位授予单位】：上海大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R318.14

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