基于EIT的整体不均匀性指数对颅脑创伤患者术后肺部感染的预测价值  

Predictive value of EIT-based global inhomogeneity index for postoperative pulmonary infection in patients with craniocerebral trauma

作　　者：查俊 李艳[2] 王鑫怡 李桂茹 王苏纯 俞又佳 乔世刚 Zha Jun;Li Yan;Wang Xinyi;Li Guiru;Wang Suchun;Yu Youjia;Qiao Shigang(Faculty of Anesthesiology,Suzhou Science&Technology Town Hospital,Suzhou 215153,China;Department of Anesthesiology,Suzhou Xiangcheng People’s Hospital,Suzhou 215131,China;Department of Critical Care Medicine,Suzhou Science&Technology Town Hospital,Suzhou 215153,China)

机构地区：[1]苏州科技城医院麻醉学部,苏州215153 [2]苏州市相城人民医院麻醉科,苏州215131 [3]苏州科技城医院重症医学科,苏州215153

出　　处：《中华急诊医学杂志》2022年第12期1642-1647,共6页Chinese Journal of Emergency Medicine

基　　金：姑苏卫生人才培养项目GSWS2019092;苏州市科技发展计划项目SYSD2019062。

摘　　要：目的探讨基于肺阻抗断层成像(EIT)技术的整体不均匀性(global inhomogeneity,GI)指数对颅脑创伤患者术后肺部感染的预测效能。方法选择90例入住苏州科技城医院的急诊颅脑创伤患者,全身麻醉下接受手术,根据术后3 d是否并发肺部感染分成肺部感染组(P3组)和非肺部感染组(NP3组),术后7 d分为P7组和NP7组。采集患者麻醉诱导前5 min内(T_(0))和气管插管后5 min(T_(1))内平均GI指数及围手术期其他各项临床数据。术后访视并记录术后3 d和7 d肺部感染的患病情况。采用受试者工作曲线(ROC曲线)评价术前GI指数对术后3 d和7 d肺部感染发生的预测价值。结果共纳入88例。其中术后3 d有26例患者并发肺部感染,患病率为29.5%。术后7 d有38例患者并发肺部感染,患病率为43.2%。术后3 d内,P3组术前格拉斯哥昏迷量表评分显著低于NP3组(P<0.05)。术后3 d内,与NP3组比较,P3组T_(1)时GI指数显著增加(P<0.001)。术后7 d内,与NP7组比较,P7组T_(1)时GI指数显著增加(P<0.05)。T_(1)时GI指数可准确预测术后3 d肺部感染(AUC=0.857,P<0.001),最佳截距值为≥0.4225(灵敏度:0.846,特异度:0.823)。T_(1)时GI指数可预测术后7 d肺部感染(AUC=0.667,P<0.05),但预测效能较差,最佳截距值为≥0.4225(灵敏度:0.579,特异度:0.780)。结论气管插管后5 min内的平均GI指数可作为术后3 d肺部感染的有效预测指标。Objective To investigate the predictive efficacy of global inhomogeneity(GI)index based on pulmonary electrical impedance tomography(EIT)in postoperative pulmonary infection of patients with craniocerebral trauma.Methods A total of 90 patients with emergency craniocerebral trauma underwent surgery under general anesthesia in Suzhou Science&Technology Town Hospital.According to the complication of pulmonary infection at the 3rd day after operation,they were divided into the pulmonary infection group(P3 group)and non-pulmonary infection group(NP3 group),and according to the complication of pulmonary infection at the 7th day after operation,they were divided into the P7 group and NP7 group.The average GI index within 5 min before anesthesia induction(T_(0))and 5 min after endotracheal intubation(T_(1))and other clinical data in the perioperative period were collected.The prevalence of pulmonary infection at the 3rd and 7th days after operation was recorded.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of preoperative GI index for pulmonary infection at the 3rd and 7th days after operation.Results A total of 88 patients were included.Among them,26 patients developed pulmonary infection within 3 days after operation,and the prevalence rate was 29.5%.Pulmonary infection occurred in 38 patients within 7 days after operation,and the prevalence rate was 43.2%.Within 3 days after operation,the preoperative Glasgow Coma Scale score in the P3 group was significantly lower than that in the NP3 group(P<0.05).Within 3 days after operation,GI index in the P3 group increased significantly at T_(1) when compared with the NP3 group(P<0.001).Within 7 days after operation,GI index in the P7 group increased signifi cantly at T_(1) when compared with the NP7 group(P<0.05).GI index at T_(1) accurately predicted pulmonary infection within 3 days after operation(AUC=0.857,P<0.001),and the best intercept value was≥0.4225(sensitivity:0.846,specifi city:0.823).GI index at T_(1) predicted pulmonary in

关 键 词：颅脑创伤 肺部感染 肺阻抗断层成像 整体不均匀性指数 

分 类 号：R651.15[医药卫生—外科学] R563.1[医药卫生—临床医学]