电阻抗成像技术在不停跳冠脉旁路移植术后肺复张中的临床应用  

Application of electrical impedance tomography for postoperative lung recruitment in patients undergoing off pump coronary artery bypass grafting surgery

作　　者：王颍骅 潘雁[2] 杨敏[1] WANG Ying-hua;PAN Yan;YANG Min(Department of Intensive Care Unit,Shanghai Chest Hospital,Shanghai Jiao Tong University,Shanghai 200030,China;Department of Pharmacy,Shanghai Chest Hospital,Shanghai Jiao Tong University,Shanghai 200030,China)

机构地区：[1]上海交通大学附属胸科医院重症监护科,上海200030 [2]上海交通大学附属胸科医院药剂科,上海200030

出　　处：《上海交通大学学报（医学版）》2018年第6期653-657,共5页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的·应用电阻抗成像技术(electrical impedance tomography,EIT)确定不停跳冠状动脉旁路移植术(off pump coronary artery bypass grafting surgery,OPCAB)术后最合适的呼气末正压(positive end expiratory pressure,PEEP),以达到改善肺通气分布情况、优化肺复张的效果。方法·入选2017年1—12月于上海交通大学附属胸科医院行OPCAB的105例患者。采用随机数余数分组法将患者分为实验组54例,对照组51例。EIT观察术后肺通气的4个兴趣区(region of interest,ROI)。对照组应用3 cm H2O PEEP;实验组调整PEEP值由0 cm H2O逐步升高至14 cm H2O,每次增加2 cm H2O,并应用最适PEEP。比较2组术后氧合指数(PaO_2/FiO_2)和肺部并发症的差异。结果·105例患者中死亡2例(1.90%),术后肺部并发症发生19例(18.10%)、肺部感染3例(2.86%)、肺不张19例(18.10%)、胸腔积液19例(18.10%)。OPCAB术后最适PEEP区间为6～9 cm H2O。实验组应用最适PEEP后,PaO_2/FiO_2显著升高(P=0.00)。与对照组相比,实验组术后肺部并发症发生率显著降低(P=0.02)。结论·应用EIT可实时直观监测OPCAB术后肺通气分布情况,滴定适合肺复张的PEEP;能够显著减少OPCAB术后肺部并发症,改善PaO_2/FiO_2,减少ICU停留时间及机械通气时间。Objective·To find out the optimal positive end expiratory pressure(PEEP)by electrical impedance tomography(EIT)for better lung recruitment and ventilation distribution in patients undergoing off pump coronary artery bypass grafting surgery(OPCAB).Methods·105 patients underwent OPCAB from Jan.2017 to Dec.2017 were analysed.Patients were randomly divided into two groups,i.e.experiment group(54 cases)and control group(51 cases).Four regions of interest(ROI)were recorded by EIT.PEEP were 3 cmH2O in control group while PEEP were increased stepwise by 2 cmH2O from 0 cmH2O to 14 cmH2O in experiment group.The optimal PEEP for lung recruitment was applied in experiment group.Postoperative oxygenation index(PaO2/FiO2)and pulmonary complication were compared between two groups.Results·The overall mortality was 2(1.90%).The incidence of postoperative pulmonary complication,pulmonary infection,atelectasis,pleural effusion were 18.10%,2.86%,18.10%,18.10%,respectively.The optimal PEEP zone was 6-9 cmH2O.PaO2/FiO2 was significantly increased with the optimal PEEP in experiment group(P=0.00).There were significant differences in postoperative pulmonary complication between two groups(P=0.02).Conclusion·EIT can directly monitor ventilation distribution and titrate suitable PEEP for better lung recruitment in patients undergoing OPCAB.It can significantly reduce postoperative pulmonary complication,improve oxygenation,and decrease ICU stay and ventilation duration.

关 键 词：电阻抗成像技术 不停跳冠状动脉旁路移植术 肺复张 呼气末正压 

分 类 号：R654.2[医药卫生—外科学]