對於心肺衰竭的病患，必須接受心肺復甦術來維持少量肺部循環，缺氧的血液作氣體交換變成含氧血，並將含氧的血液送至全身，但在於傳統的從外部心肺復甦送出去的血液供給極為有限，所以醫療演變出能取代外部心肺復甦氣體交換的限制，且能達到高效率支持血壓的兩大重要功能，臨床稱之為葉克膜（Extracorporeal Membrane Oxygenation , ECMO），電腦斷層執行影像增對比增強掃描的合適方法尚無共識。由於葉克膜會導致血液動力學改變，因此對比度分佈會有所不同，因此可能會導致成像效果不佳。葉克膜使用較廣為人知的是，運用在急性心肌梗塞造成全身器官供應不足所致的心因性休克患者，以提供血流動力學支持（靜脈-動脈葉克膜）。但是在臨床上，如果沒有足夠提供又快速又有效的方法，將無法快速辨別患者衰竭原因，也因為時間慢慢的拖長使存活率大幅度的降低，目前電腦斷層是最能快速檢查及快速判別提供影像的協助方法，葉克膜通常反而會導致成像效果不佳結果。由於電腦斷層影像學的精確診斷對於解剖，伴隨胃腸道出血和腹主動脈瘤的患者是非常重要的利器。
在這項研究中，在不改變任何掃描方法和顯影劑劑量條件的情況下，收集了兩組的普通人群（N = 36）和葉克膜組（N = 31），測量電腦斷層數並在相對解剖位置進行比較，結果存在顯著差異。這項研究探索了心臟和葉克膜引起的顯影劑亮度和流動方向變化的結果，正常的流向是從身體的上半身往腳底方向前進，但因為葉克膜血流方向是從腳底往身體上半身前進，是屬於逆行性的血流會造成血液不均勻分布問題，顯影劑也會因這樣的狀況造成顯影效果有所差異，利用這樣的差異分析，未來可以提高電腦斷層血管造影的掃描時機，以及在醫師判斷軟組織或血管區別上，大大增加診斷的準確度。

For patients with cardiopulmonary failure, cardiopulmonary resuscitation must be performed to maintain a small amount of pulmonary circulation. The hypoxic blood is exchanged for gas to become oxygenated blood, and the oxygenated blood is sent to the whole body. However, in the traditional external cardiopulmonary resuscitation. The blood supply going out is extremely limited, so medical treatment has evolved to replace the limitation of external cardiopulmonary resuscitation gas exchange, and can achieve two important functions of high-efficiency support of blood pressure. It is clinically called Extracorporeal Membrane Oxygenation (ECMO). There is no consensus on the appropriate method for performing image-enhanced scanning on tomography. Since ECMO will cause hemodynamic changes, the contrast distribution will be different, which may lead to poor imaging results. ECMO is widely known to be used in patients with cardiogenic shock caused by insufficient supply of systemic organs due to acute myocardial infarction to provide hemodynamic support (venous-arterial mode). However, in clinical practice, if there are not enough quick and effective methods, it will not be able to quickly identify the cause of the disease, and the survival rate will be greatly reduced due to the slow time When ECMO the assisting method for providing images, ECMO usually leads to poor imaging results. Because the accurate diagnosis of computer tomography is a very important tool for anatomy, patients with gastrointestinal bleeding and abdominal aortic aneurysms.
In this study, without changing any scanning methods and contrast dose conditions, the general population group (N=36) and the ECMO group (N=31) were collected for two groups. CT numbers were measured and compared in relative anatomical positions. The results There are significant differences. This study explores the results of changes in the brightness and flows direction of the contrast agent caused by the heart and of the ECMO, which can increase the diagnostic value of CT angiography.

摘要 ii
Abstract iii
誌謝 iv
目錄 v
圖目錄 vi
表目錄 vii
第一章 緒論 1
1.1 研究背景 1
1.2 研究動機 2
1.3 研究目的 3
1.4 論文架構 3
第二章 文獻回顧與探討 5
2.1 電腦斷層運用 5
2.2 葉克膜急救發展 12
2.3 顯影劑探討 13
第三章 研究方法 16
3.1 研究設計 16
3.1.1 電腦斷層掃描設計 16
3.1.2 靜脈-動脈葉克膜模式 17
3.2 實驗設計 19
3.2.1 葉克膜裝置 19
3.2.2 電腦斷層執行 20
3.2.3 電腦斷層值及ImageJ軟體 22
3.2.4 統計方式 24
3.3 資料收集及驗證 24
3.3.1 電腦斷層值量測 24
3.3.2 ImageJ軟體分析 24
第四章 實驗驗證 26
4.1 個案醫院背景 26
4.2 腹部動脈攝影與葉克膜支持 26
4.3 ImageJ分析結果 27
4.4 實驗規劃 28
4.4.1 收案條件 28
4.4.2 收案資料 28
4.4.3 統計分析 29
第五章 結論及建議 33
5.1 結論 33
5.2 研究限制 34
5.3 未來研究方向 34
參考文獻 35
附錄一 38
附錄二 39

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