本研究之主旨為開發二合一的檢測試片，同時檢測血清中的巴拉刈與肌酸酐濃度，提供臨床醫師一個在診斷巴拉刈中毒病人時，快速確診而不被地理環境所限制的方式。
巴拉刈於農業上使用效果良好，是全世界最廣泛使用的除草劑來源，然而，由於其對人體的高度毒性，微小的吞入量即可能造成吞入者的高致死率。臨床上使用 SIPP ( Severity Index of Paraquat Poisoning ) 作為診斷指標，以喝下巴拉刈到接受治療時間 ( Hour )乘以血液中的巴拉刈濃度 ( ppm )，若其乘積大於10，則患者便會被判定為高危險群，存活率較低。從臨床的觀點而言，治療巴拉刈中毒病人的診療上，「時間」是一個決定性的關鍵因素。
巴拉刈中毒的患者常常合併有多重性器官衰竭，肌酸酐作為判定腎功能的功能性指標，是判定是否有腎臟衰竭的標的，本研究中，開發 2-in-1 PADs 同時測試巴拉刈和肌酸酐在血清中的濃度，能夠有效的幫助巴拉刈中毒患者立即性的確診、治療以及預後。

This study aims to develop a comprehensive 2-in-1 PAD to detect the concentrations of Paraquat and creatinine in serum, which can help clinicians diagnose patients with severe Paraquat poisoning in a more rapid and geographically unrestricted manner.
Due to its efficacy, Paraquat is the most widely used herbicide in the world. However, it is also highly toxic, and lethal in minute doses. The term SIPP (Severity Index of Paraquat Poisoning) is a common terminology in the diagnosis of Paraquat. The severity index of the poisoned patient is calculated using the Paraquat blood concentration (ppm) multiplied by the time taken between exposure to Paraquat and accepting therapy (hr). If the value exceeds 10, the patient is considered to be at high risk, and the survival rate will be significantly reduced. From a clinical point of view, "time" is a key factor in the treatment of Paraquat poisoning patients.
In this study, the 2-in-1 PADs was developed to measure the concentration of Paraquat and creatinine. Creatinine concentrations serve as an indicator in the detection of renal function, can provide effective functional information, and would greatly assist the prompt diagnosis, treatment and rehabilitation of Paraquat poisoning patients.

中文摘要 II
英文摘要……………………………………………………………………………………..IV
致謝 IV
目錄…………………………………………………………………………………………..VI
表目錄 IX
圖目錄 X
符號對照表 XII
第一章 緒論 1
1.1 巴拉刈介紹 1
1.1.1巴拉刈中毒現況 1
1.1.2 巴拉刈的治療與預後 3
1.2肌酸酐檢測與巴拉刈中毒檢測關係 5
1.2.1 巴拉刈中毒與腎臟衰竭 5
1.2.2 目前市面上肌酸酐檢測產品 6
1.3 Point Of Care ( POC ) 發展 7
1.3.1 Point Of Care 簡介 7
1.3.2 紙基檢測 9
1.3.3 蠟印技術 11
1.4 呈色法介紹 12
1.4.1 酶分析 12
1.4.2 Colorimetric transduction 14
1.4.3 奈米粒子 15
1.4.5 其他方法 15
1.5 動機與實驗流程 18
1.5.1 研究動機 18
1.5.2 實驗流程 19
第二章 材料與方法 20
2.1 材料 20
2.1.1 藥物 20
2.1.2 器材 20
2.1.3 檢體 21
2.2 臨床檢驗 21
2.2.1 臨床檢驗使用機台介紹 21
2.3 單一試片條件測試 23
2.3.1 裝置展示 23
2.3.2 紙基材種類 25
2.3.3 反應區形狀 26
2.3.4 各部分實驗使用之 Pattern 27
2.3.5 Wax Printing 條件測試 29
2.3.6 製作試紙步驟 30
2.4 Paraquat 檢量線建立 31
2.4.1 Paraquat 檢測試驗 Framework 31
2.4.2 Paraquat 呈色反應 31
2.4.3 Paraquat 檢測步驟 32
2.4.4 反應順序測定 32
2.5 Creatinine 檢量線建立 34
2.5.1 Creatinine 檢測試驗 Framework 34
2.5.2 Creatinine 呈色反應 34
2.5.3 Creatinine 檢測步驟 36
2.6 2-in-1 PADs 研製 37
2.6.1 以 FBS 測試二合一試片 37
2.6.2 摺疊試片測試 38
2.6.3 複合材料測試 38
2.6.4 測試流道長度與孔洞大小參數 39
2.6.5 2-in-1 PADs 使用步驟 40
2.6.6 可視化試片探討 41
2.7 分析 42
2.8 以Excel 程式代入檢量線公式推測濃度值 43
第三章 實驗條件測試 45
3.1 紙質與形狀測試討論 45
3.2 蠟印參數條件測試討論 46
3.3 探討紙張不平影響結果 47
3.4 紙基混合狀態討論 48
第四章 巴拉刈和肌酸酐檢測 49
4.1 巴拉刈檢測 49
4.1.1 巴拉刈之反應順序討論 49
4.1.2 最佳反應時間 51
4.1.3 關於標準曲線中是否加入0 ppm 探討 51
4.1.4 巴拉刈在 buffer system 跟 serum system 的曲線差異 52
4.2肌酸酐檢測 53
4.2.1 裝置底色差異討論 53
4.2.2 Creatinine 在 serum system 和在 Buffer system 的表現差異 54
第五章 2-in-1 PADs 研製 56
5.1 摺疊試片結果討論 56
5.2 複合材料使用之探討 57
5.3 呈色之樣本液體體積對攝像之影響 58
5.4 可視化試片之試驗結果討論 59
第六章 檢體測試結果展示 61
6.1 2-in-1 之測試結果與醫院值比較 61
6.2 Linear regression analysis of creatinine detection 62
6.3 檢體血清基本狀態探討 63
6.4 臨床檢體資料表 64
第七章 結論與未來展望 65
7.1 未來可能研究方向 65
7.2 結論 66
第八章 參考文獻 68

第八章 參考文獻


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