机械通气下肺血流灌注状况的电阻抗断层成像评估新方法研究
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摘要
目的针对机械通气下重症患者肺灌注功能评估的临床需求,本文提出一种新的基于造影剂增强的电阻抗断层成像(Electrical Impedance Tomography,EIT)评估方法。方法机械通气过程中,将呼吸机暂时设置为呼气末屏气状态,并在此期间注射10 mL浓度为10%高渗盐水作为造影剂。通过计算EIT功能图像得到单纯的肺感兴趣区,随后由注射造影剂后阻抗下降的平均斜率评估血流灌注情况。结果本方法所得肺灌注分布图和心灌注分布图能够客观反映各像素的灌注量百分比占比。结论作为一种床旁监护技术,EIT可用于评估肺血流灌注分布情况,为医生改善机械通气的治疗效果提供有价值的参考诊断信息。
Objective To evaluate the lung perfusion function of the intensive patient under mechanical ventilation, this paper proposed a new assessment method based on contrast agent enhancement by electrical impedance tomography(EIT). Methods During mechanical ventilation, the ventilator was temporarily set as the breath hold state at the end of exhalation, and 10 mL of hypertonic saline was injected during this period as contrast agent. The pure lung region of interest was determined by calculating functional EIT image, then the perfusion was evaluated by the slope of impedance reduction after injecting the agent. Results The lung and heart perfusion distribution map obtained by the proposed method could objectively reflect the perfusion percentage of each pixel. Conclusion EIT can be used to evaluate the distribution of lung and perfusion, and provide some valuable diagnostic information to doctors for improving the effect of mechanical ventilation.
Objective To evaluate the lung perfusion function of the intensive patient under mechanical ventilation, this paper proposed a new assessment method based on contrast agent enhancement by electrical impedance tomography(EIT). Methods During mechanical ventilation, the ventilator was temporarily set as the breath hold state at the end of exhalation, and 10 mL of hypertonic saline was injected during this period as contrast agent. The pure lung region of interest was determined by calculating functional EIT image, then the perfusion was evaluated by the slope of impedance reduction after injecting the agent. Results The lung and heart perfusion distribution map obtained by the proposed method could objectively reflect the perfusion percentage of each pixel. Conclusion EIT can be used to evaluate the distribution of lung and perfusion, and provide some valuable diagnostic information to doctors for improving the effect of mechanical ventilation.
引文
[1]朱蕾.机械通气[M].上海:上海科学技术出版社,2012.
[2]吴江萌.SPECT/CT核素肺通气/灌注断层融合显像对肺动脉血栓栓塞症的诊断价值[D].石家庄:河北医科大学,2017.
[3]Eyüboglu BM,Brown BH.Methods of cardiac gating applied potential tomography[A].Clinical Physics and Physiological Measurement:An Official Journal of the Hospital Physicists’Association,Deutsche Gesellschaft für Medizinische Physik and the European Federation of Organisations for Medical Physics[C].1988.
[4]Barber DC.Quantification in impedance imaging[A].Clinical Physics and Physiological Measurement:an Official Journal of the Hospital Physicists’Association,Deutsche Gesellschaft für Medizinische Physik and the European Federation of Organisations for Medical Physics[C].1990.
[5]Deibele JM,Luepschen H,Leonhardt S.Dynamic separation of pulmonary and cardiac changes in electrical impedance tomography[J].Physiol Meas,2008,29(6):S1.
[6]Frerichs I,Pulletz S,Elke G,et al.Assessment of changes in distribution of lung perfusion by electrical impedance tomography[J].Respiration,2009,77(3):282.
[7]Smit HJ,Handoko ML,Noordegraaf AV,et al.Electrical impedance tomography to measure pulmonary perfusion:is the reproducibility high enough for clinical practice?[J].Physiol Meas,2003,24(2):491-499.
[8]Borges JB,Suarez-Sipmann F,Bohm SH,et al.Regional lung perfusion estimated by electrical impedance tomography in a piglet model of lung collapse[J].J Appl Phys,2012,112(1):225-236.
[9]Fagerberg A,Stenqvist O,?neman A.Monitoring pulmonary perfusion by electrical impedance tomography:an evaluation in a pig model[J].Acta Anaesthesiol Scand,2009,53(2):152.
[10]Smit HJ,Vonk NA,Marcus JT,et al.Determinants of pulmonary perfusion measured by electrical impedance tomography[J].Eur J Appl Physiol,2004,92(1-2):45-49.
[11]Kühnel G,Hahn G,Frerichs I,et al.New methods for improving the image quality of functional electric impedance tomography[J].Biomed Tech Biom Eng,1997,42(S1):470.
[12]Frerichs I,Amato MB,van Kaam AH,et al.Chest electrical impedance tomography examination,data analysis,terminology,clinical use and recommendations:consensus statement of the translational EIT development study group[J].Thorax,2017,72(1):83-93.
[13]Fagerberg A,Stenqvist O,?neman A.Electrical impedance tomography applied to assess matching of pulmonary ventilation and perfusion in a porcine experimental model[J].Crit Care,2009,13(2):R34.
[14]Nd VNA,Janse A,Marcus JT,et al.Determination of stroke volume by means of electrical impedance tomography[J].Physiol Meas,2000,21(2):285-293.
[15]Zadehkoochak M,Blott BH,Hames TK,et al.Pulmonary perfusion and ventricular ejection imaging by frequency domain filtering of EIT(electrical impedance tomography)images[J].Clin Phys Physiol Meas,1992,13(SA):191-196.
[16]Elke G,Pulletz S,Sch?dler D,et al.Measurement of regional pulmonary oxygen uptake--a novel approach using electrical impedance tomography[J].Physiol Meas,2011,32(7):877.
[2]吴江萌.SPECT/CT核素肺通气/灌注断层融合显像对肺动脉血栓栓塞症的诊断价值[D].石家庄:河北医科大学,2017.
[3]Eyüboglu BM,Brown BH.Methods of cardiac gating applied potential tomography[A].Clinical Physics and Physiological Measurement:An Official Journal of the Hospital Physicists’Association,Deutsche Gesellschaft für Medizinische Physik and the European Federation of Organisations for Medical Physics[C].1988.
[4]Barber DC.Quantification in impedance imaging[A].Clinical Physics and Physiological Measurement:an Official Journal of the Hospital Physicists’Association,Deutsche Gesellschaft für Medizinische Physik and the European Federation of Organisations for Medical Physics[C].1990.
[5]Deibele JM,Luepschen H,Leonhardt S.Dynamic separation of pulmonary and cardiac changes in electrical impedance tomography[J].Physiol Meas,2008,29(6):S1.
[6]Frerichs I,Pulletz S,Elke G,et al.Assessment of changes in distribution of lung perfusion by electrical impedance tomography[J].Respiration,2009,77(3):282.
[7]Smit HJ,Handoko ML,Noordegraaf AV,et al.Electrical impedance tomography to measure pulmonary perfusion:is the reproducibility high enough for clinical practice?[J].Physiol Meas,2003,24(2):491-499.
[8]Borges JB,Suarez-Sipmann F,Bohm SH,et al.Regional lung perfusion estimated by electrical impedance tomography in a piglet model of lung collapse[J].J Appl Phys,2012,112(1):225-236.
[9]Fagerberg A,Stenqvist O,?neman A.Monitoring pulmonary perfusion by electrical impedance tomography:an evaluation in a pig model[J].Acta Anaesthesiol Scand,2009,53(2):152.
[10]Smit HJ,Vonk NA,Marcus JT,et al.Determinants of pulmonary perfusion measured by electrical impedance tomography[J].Eur J Appl Physiol,2004,92(1-2):45-49.
[11]Kühnel G,Hahn G,Frerichs I,et al.New methods for improving the image quality of functional electric impedance tomography[J].Biomed Tech Biom Eng,1997,42(S1):470.
[12]Frerichs I,Amato MB,van Kaam AH,et al.Chest electrical impedance tomography examination,data analysis,terminology,clinical use and recommendations:consensus statement of the translational EIT development study group[J].Thorax,2017,72(1):83-93.
[13]Fagerberg A,Stenqvist O,?neman A.Electrical impedance tomography applied to assess matching of pulmonary ventilation and perfusion in a porcine experimental model[J].Crit Care,2009,13(2):R34.
[14]Nd VNA,Janse A,Marcus JT,et al.Determination of stroke volume by means of electrical impedance tomography[J].Physiol Meas,2000,21(2):285-293.
[15]Zadehkoochak M,Blott BH,Hames TK,et al.Pulmonary perfusion and ventricular ejection imaging by frequency domain filtering of EIT(electrical impedance tomography)images[J].Clin Phys Physiol Meas,1992,13(SA):191-196.
[16]Elke G,Pulletz S,Sch?dler D,et al.Measurement of regional pulmonary oxygen uptake--a novel approach using electrical impedance tomography[J].Physiol Meas,2011,32(7):877.