肺电阻抗断层成像对重症患者拔管失败的预测价值  

The predictive value of electrical impedance tomography for extubation failure in critically ill patients

作　　者：笪伟[1] 牛明玥 朱甜甜 王晓波 梁培培[1] 谢晓东[1] 陈蕊 李冉 丁振兴[1] 张泓[1] Da Wei;Niu MingYue;Zhu Tiantian;Wang Xiaobo;Liang Peipei;Xie Xiaodong;Chen Rui;Li Rang;Ding Zhenxing;Zhang Hong(Department of Emergency Medicine,The First Affiliated Hospital of Anhui Medical University,Hefei 230032,China)

机构地区：[1]安徽医科大学第一附属医院急诊医学科,合肥230032

出　　处：《中华急诊医学杂志》2024年第12期1743-1747,共5页Chinese Journal of Emergency Medicine

基　　金：安徽省科研编制计划项目(2023AH040079)。

摘　　要：目的分析有创机械通气(mechanical ventilation,MV)的重症患者在脱机拔管阶段的肺电阻抗断层成像(electrical impedance tomography,EIT)的变化特点,评估EIT预测重症患者拔管失败的价值。方法前瞻性顺序收集2022年1月至2024年1月安徽医科大学第一附属医院急诊重症监护病房(emergency intensive care unit,EICU)行有创MV并进行自主呼吸试验(spontaneous breathing trial,SBT)患者的临床资料。监测并记录患者压力支持通气时、SBT通过后拔管后2 h和拔管后6 h EIT的数值。根据患者拔管后48 h内是否重新插管,分为拔管成功组和拔管失败组。对两组EIT的数值进行组间相同时间点的比较,并将EIT的数值进行相关性分析。采用受试者操作特性曲线(receiver operating characteristic,ROC)分析压力支持通气时、SBT通过后拔管后2 h和拔管后6 h EIT对拔管失败的预测能力。结果共纳入研究患者110例,其中52例患者拔管失败。拔管失败组的患者比拔管成功组的患者在拔管前、拔管后具有更小的可用通气面积(surface available for ventilation,SAV),而且全肺非均质(global inhomogeneity index,GI)指数较高(P<0.001)。两组间的通气延迟区域(the regional ventilation delay,RVD)和通气中心(the center of ventilation,COV)没有差异。结论EIT的结果是重症患者拔管失败的有效的预测指标,并适合进行临床应用。Objective To analyze the changes in electrical impedance tomography(EIT)during the extubation phase in critically ill patients undergoing invasive mechanical ventilation(MV),and evaluate the value of EIT and EAdi in predicting extubation failure in critically ill patients.Methods The clinical data of patients undergoing invasive mechanical ventilation and SBT in the emergency intensive care unit(EICU)of the First Affiliated Hospital of Anhui Medical University from January 2022 to June 2024 were prospectively collected.The values of EIT were monitored and recorded at pressure support ventilation,2 hours after extubation and 6 hours after extubation.According to whether the patient was re-intubated within 48 hours after extubation,patients were divided into successful extubation group and extubation failure group.The values of EIT were compared at the same time point between the two groups,and the correlation analysis of the values of EIT was carried out.The ROC curve was used to analyze the predictive ability of EIT at pressure support ventilation, 2 hours after extubation and 6 hours after extubation after SBT passage for extubation failure. Results A total of 110 patients were included in the study, of which 52 patients failed to extubation. Patients in the failed extubation group had a smaller available ventilation area (SAV) before and after extubation compared to those in the successful extubation group, and had a higher Global Inhomogeneity Index (GI)( P < 0.001). The regional ventilation delay and the the center of ventilation were not different between groups. Conclusions The values of EIT are valid predictors of extubation failure in critically ill patients and are suitable for clinical application.

关 键 词：机械通气 拔管失败 肺电阻抗断层成像 自主呼吸试验 

分 类 号：R459.7[医药卫生—急诊医学]