用电阻抗断层成像测量阻塞性肺疾病急性加重期局部空气滞留:一项可行性研究

用电阻抗断层成像测量阻塞性肺疾病急性加重期局部空气滞留:一项可行性研究

贵州医科大学     麻醉与心脏电生理课题组

翻译：李奕  编辑：张中伟  审核：曹莹

罂 粟 摘 要 

背景：由于支气管异常通常表现出空间不均匀性，这可能无法通过常规的整体肺功能测量来正确评估，因此区域信息可能有助于表现疾病进展。我们假设机械通气期间的局部空气潴留可以通过电阻抗断层成像(EIT)得出的局部呼气末流量(EEF)来表现。

方法：对25名患有慢性阻塞性肺疾病(COPD3级或4级)或严重哮喘急性加重的患者进行了前瞻性研究。患者在辅助控制模式下进行通气。连续两天，在吸入皮质类固醇和长效β2激动剂之前和之后1小时进行EIT测量。计算区域EEF作为肺区域中每个图像像素的相对阻抗的导数。结果被标准化为由呼吸机测量的总流量值。

结果：区域和整体EEF高度相关(P<0.00001)，药物治疗和疾病进展的区域效应在区域EEF图中可见。COPD患者用药前后肺部区域EEF总和分别为3.8 [2.0，5.1]和3.6 [1.9，4.5] L/min(中位数[下，上四分位数]；P=0.37)。哮喘患者的相应值为3.0 [2.5，4.2]和2.2 [1.7，3.2] L/min (P<0.05)。局部EEF直方图显示用药前EEF的高度空间异质性。经过一天的治疗后，直方图显示出较少的异质性和EEF水平的降低。

结论：局部EEF描述了空气潴留和内源性PEEP，这可以为治疗期间监测疾病进展提供诊断信息。

原始文献来源：Zhanqi Zhao , Mei-Yun Chang , Inéz Frerichs, et al. Regional air trapping in acute exacerbation of obstructive lung diseases measured with electrical impedance tomography: a feasibility study.[J]. Minerva Anestesiol. 2020 Feb;86(2):172-180.

英文原文 

Regional air trapping in acute exacerbation of obstructive lung diseases measured with electrical impedance tomography: a feasibility study

Abstract

Background: Since bronchial abnormalities often exhibit spatial non-uniformity which may be not correctly assessed by conventional global lung function measures, regional information may help to characterize the disease progress. We hypothesized that regional air trapping during mechanical ventilation could be characterized by regional end-expiratory flow (EEF) derived from electrical impedance tomography (EIT).

Method:  Twenty-five patients suffering from chronic obstructive pulmonary disease (COPD grade 3 or 4) or severe asthma with acute exacerbation were examined prospectively. Patients were ventilated under assist-control mode. EIT measurements were conducted before and one hour after inhaled combined corticosteroid and long-acting β2 agonist, on two consecutive days. Regional EEF was calculated as derivative of relative impedance for every image pixel in the lung regions. The results were normalized to global flow values measured by the ventilator.

Results: Regional and global EEF were highly correlated (P<0.00001) and regional effects of medication and disease progression were visible in the regional EEF maps. The sums of regional EEF in lung regions were 3.8 [2.0, 5.1] and 3.6 [1.9, 4.5] L/min in COPD patients before and after medication (median [lower, upper quartiles]; P=0.37). The corresponding values in asthma patients were 3.0 [2.5, 4.2] and 2.2 [1.7, 3.2] L/min (P<0.05). Histograms of regional EEF showed high spatial heterogeneity of EEF before medication. After one day of treatment, the histograms exhibited less heterogeneous and a decrease in EEF level.

Conclusion: Regional EEF characterizes air trapping and intrinsic PEEP, which could provide diagnostic information for monitoring the disease progress during treatment.

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