奇美醫院運用AI低血壓風險預測系統 掌握洗腎過程中突發低血壓 智慧監控更安全
2023-02-02 記者姚瑞／台南報導
主講者腎臟科主治醫師楊翼寧(左)與血液透析室護理長黃惠暄及其講題。
奇美醫院運用AI低血壓風險預測系統與透析照護指引流程，讓血液透析病人併發透析低血壓，可以運用AI提前調控洗腎參數，奇美醫學中心腎臟科主治醫師楊翼寧說明：透析中低血壓(IDH)是血液透析病人心中永遠的恐懼，也是醫護最擔心、最棘手的問題，因它會造成病人透析中嚴重的不適，如噁心、嘔吐、胸口悶痛、肢體抽筋、甚至意識喪失。低血壓會連帶影響各個重要器官的灌流，讓器官處於缺血缺氧的狀態，因而容易產生透析相關的併發症，常見的有心肌缺血、腸胃道缺血、腦中風及透析血管通路阻塞等，進而增加病人的死亡率。
奇美醫學中心統計血液透析約有25%發生低血壓，四痛點無法有效解決。奇美醫學中心血液透析室護理長黃惠暄說明：根據奇美醫學中心血液透析室統計2010至2020年血液透析病人約有25%於洗腎過程中發生低血壓。過去的研究顯示透析中低血壓的盛行率約5至50%，各地盛行率的懸殊差異與使用的定義有關。因此，雖然透析中低血壓已被研究多年，眾多的危險因子也逐一被釐清，如年紀大、女性、低白蛋白、貧血、透析間體重變化量大者等，但礙於以下幾點原因，使得這個重要的議題一直無法獲得有效的解決，包括：一、透析中低血壓之定義至今無國際共識；二、血液透析病人病況複雜且透析過程資訊量龐大；三、每個病人的危險因子不盡相同且低血壓臨床表現多樣；四、難以針對個別病人之風險進行精準預測。
鑑於上述困難點，奇美醫學中心腎臟科與醫療大數據庫暨人工智慧運算(AI)中心於2020年底開始合作，組成了優質的AI跨領域團隊(另含院方科部資源、血液透析室護理師、資訊室)，希望運用AI機器學習(ML)善於處理大數據與多重複雜問題的優勢來幫助血液透析病人遠離透析中低血壓。
「AI低血壓風險預測系統」與「透析照護指引流程」大幅降低洗腎中的風險，提昇就醫病人的安全性及品質。
透過AI大數據及照護指引監控透析風險，醫療輔助分析透析者狀態
奇美醫學中心腎臟科主治醫師楊翼寧說明：透析病人每個月平均進行血液透析12至13次、每次得花上4小時，過程中光是一位病人就得監測上百筆的血流速、血壓、脫水速度及脫水量等數值。過往經常仰賴醫師的臨床經驗判斷及護理師臨場應變能力，然而，即便是經驗豐富的醫護人員也不易掌握病情變化。
奇美醫學中心血液透析室護理長黃惠暄指出：如何面對及處理透析中低血壓對血液透析護理師來說是夢靨也是挑戰，護理師需眼明手快，迅速做出反應，甚至尋求醫療團隊支援。透析中低血壓除了會造成病人眾多不適症狀外也會造成當日透析無法順利脫水，脫水量無法達標對護理師及病人而言是極大的壓力，此時必須與時間賽跑，唯有在病人血壓穩定且無不適症狀下才有機會重新調整脫水速率，故透析中低血壓導致無法脫水一事不僅會延遲病人透析時間，也會增加病人治療過程中的焦慮與不安。
奇美醫學中心為了帶給病人更精準、安全的血液透析過程，導入了近7萬筆的透析病人參數資訊的大數據資料，透過大數據的演算法分析，研發出『AI低血壓的風險預測系統』，並結合此系統制訂『透析照護指引流程』，提早找出高風險病人並即時給予預防介入措施(例如：提高雙下肢、給氧氣、調整脫水速率及血流速，甚至給輸液或升壓藥等)來確保病人透析中的安全與品質，能精準掌握透析病人的各項數據，達到『預防勝於治療』的醫療目標。。
奇美醫學中心實際於血液透析室運用「AI低血壓風險預測系統」即時監控洗腎病人情況，讓醫療團隊及早、即時給予適當的預防和介入措施。
低血壓風險預測延伸至未洗腎前，率先研發兩階段風險預測系統！
奇美醫學中心腎臟科主治醫師楊翼寧指出：為了能更早地找出高風險的病人，讓醫護有更充足的準備時間，團隊將低血壓的風險預測時機延伸至透析前，因此率先研發『兩階段』AI低血壓的風險預測系統。
在透析前(第一階段)，先透過AI低血壓的風險預測系統快速分析和預警當前的病人狀態，並設定較佳的血液透析機參數，如：血流速、脫水量、溫度等，以減少因透析產生的低血壓、眩暈等不適，且醫護團隊也可提早因應或立即處理；在透析中(第二階段)，再次透過AI低血壓的風險預測系統監測，同時腎臟科醫師則透過病人歷史透析資料分析結果，來衛教病人加強水分控制。
『AI低血壓的風險預測系統』經過8種機器學習的演算法取其最佳模型來實作上線，指標不論於透析前(圖1)、透析後皆非常優異，與國內其他醫學中心和韓國首爾大學的系統相比，本系統採適量的特徵值即可獲得優異且不亞於國際系統的預測結果(表1)。本透析低血壓風險預測系統於2021年9月正式上線，醫護團隊使用後的滿意度高，後續為了讓預防與介入措施標準化，更進一步將預測風險值結合奇美醫學中心血液透析室所制定的『透析照護指引流程』。
奇美醫學中心掌握洗腎過程中突發低血壓，智慧監控更安全！研發AI低血壓風險預測系統與透析照護指引流程，雙管齊下揪出高風險。
AI低血壓風險預測系統上線後，透析中低血壓發生率降低5.5%
奇美醫學中心腎臟科主治醫師楊翼寧表示：『AI低血壓的風險預測系統』上線後經統計和年齡、性別的校正後，2021年10至12月的透析中低血壓發生率20.6%相較2020年10至12月的透析中低血壓發生率26.1%，顯著地降低5.5%(表2)。奇美醫學中心AI團隊於去(2022)年已將此成果發表在國際醫療資訊研討會(ICMHI 2022，最佳論文)、台灣腎臟醫學會期刊(Acta Nephrologica)與國際知名醫學期刊(Journal of Healthcare Engineering)；成就更榮獲第23屆國家醫療品質獎-智慧解決方案組『標章』的肯定。
綜合上述的研究結果，可知奇美醫學中心腎臟科與AI大數據中心所合力研發的AI預測系統能準確預測血液透析病人透析中低血壓的風險，讓醫療團隊及早、即時給予適當的預防和介入措施，大大降低了低血壓的發生率，幫助血液透析病人『腎』力抗壓、遠離低壓的恐懼！
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