机械通气下采用EIT与CT滴定最佳呼气末正压的对比研究  

Comparative study of optimal positive end-expiratory pressure titration by EIT and CT under mechanical ventilation

作　　者：周嘉渝 曲志华 代萌 ZHOU Jia-yu;QU Zhi-hua;DAI Meng(Basic Medical Science Academy,Air Force Medical University,Xi'an 710032,China;Medical Imaging Division,Shenzhen Mindray Bio-Medical Electronics Co.,Ltd.,Shenzhen 518132,Guangdong Province,China;Military Biomedical Engineering School,Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学基础医学院,西安710032 [2]深圳迈瑞生物医疗电子股份有限公司医学影像事业部,广东深圳518132 [3]空军军医大学军事生物医学工程学系,西安710032

出　　处：《医疗卫生装备》2023年第5期10-14,共5页Chinese Medical Equipment Journal

基　　金：国家自然科学基金项目(52277235);国家科技部重点研发计划项目(2022YFC2404802)。

摘　　要：目的:比较机械通气下采用CT与电阻抗断层成像(electrical impedance imaging,EIT)滴定最佳呼气末正压(positive end-expiratory pressure,PEEP)的差异,以证实采用EIT滴定PEEP的可行性。方法:先对7只小猪建立急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)模型,然后在不同PEEP水平下进行机械通气,同时采集EIT和CT数据;通过对CT图像进行分割获得肺塌陷(collapse,CL)和过度膨胀(over-distension,OD)区域的比例并滴定PEEP值,基于EIT图像计算呼吸阻抗顺应性获得肺CL和OD区域的比例并滴定PEEP值,并比较两者获得的PEEP值的差异性。结果:基于CT图像滴定的最佳PEEP值为(6±2)cmH_(2)O(1 cmH_(2)O=98.06 Pa),基于EIT方法滴定的最佳PEEP值为(8±2)cmH_(2)O,基于EIT方法滴定的PEEP值略高,但两者差异无统计学意义(P=0.09>0.05)。结论:EIT作为一种无创无辐射的床旁肺通气监测手段,适用于对ARDS患者的机械通气进行PEEP滴定。Objective To compare CT and EIT used for optimal positive end-expiratory pressure(PEEP)titration under mechanical ventilation to verify the feasibility of EIT for PEEP titration.Methods Seven piglets were used to establish acute respiratory distress syndrome(ARDS)models,then mechanical ventilation was performed at different PEEP levels,and EIT and CT data were collected simultaneously;by segmenting CT images the proportions of lung collapse(CL)and over-distension(OD)regions were made clear and titrated PEEP values were obtained,based on EIT images respiratory impedance compliance was calculated to determine the proportions of lung CL and OD regions and titrated PEEP values,then the PEEP values acquired by CT and EIT were compared.Results The optimal PEEP value obtained by EIT images((8±2)cmH_(2)O)(1 cmH_(2)O=98.06 Pa)was slightly higher than that by CT images((6±2)cmH_(2)O),while the difference had no statistical significance(P=0.09>0.05).Conclusion EIT is noninvasive and radiation-free during bedside lung ventilation monitoring,and can be used for PEEP titration of ARDS mechanical ventilation.[Chinese Medical Equipment Journal,2023,44(5):10-14]

关 键 词：机械通气 CT 电阻抗断层成像 PEEP滴定 急性呼吸窘迫综合征 

分 类 号：R318[医药卫生—生物医学工程]