应用EIT技术监测ICU心外科术后患者肺部通气情况及其价值初探

Applying the Electrical Impedance Tomography to Assess Lung Regional Ventilation Distribution in ICU Patients After Cardiac Surgery and Exploring Its Preliminary Values

目的 应用电阻抗断层成像(electrical impedance tomography, EIT)技术监测ICU心外科术后患者的肺部通气情况,并分析其在患者术后短期预后预测中的价值。方法 回顾性收集北京协和医院重症医学科2023年1月—11月收治的心外科术后患者临床资料,应用EIT技术监测患者肺部通气情况,分析患者4个感兴趣区(region of interest, ROI)肺通气百分比对患者ICU住院时间、呼吸机使用时间和插管时间的影响。结果 共46例患者纳入本研究,其中男性29例,女性17例,平均年龄(58.2±9.5)岁。手术时长≥5 h的患者肺平行ROI 4区(背侧)通气更差(P=0.022)。而ROI 4区通气<9%的患者其氧合指数更低(P=0.025),呼吸机使用时间(P=0.004)、插管时间(P=0.010)、ICU住院时间(P=0.018)均更长。在控制年龄、性别、手术时长和入室急性生理学与慢性健康状况(acute physiology and chronic health evaluation, APACHE)评分的影响后,肺平行ROI 4区通气增加是患者术后短期预后的保护性因素(OR=0.743,95%CI:0.587~0.941,P=0.014)。以9.5%为截点,肺平行ROI 4区肺通气百分比预测患者预后差的灵敏度为85.7%,特异度为56.2%,曲线下面积为0.752(95%CI:0.599~0.905,P=0.007)。结论 应用EIT监测技术,可观察到ICU心外科手术后患者肺部通气情况与手术时长有关,改善患者肺部ROI 4区通气或可提高患者术后短期预后。

Objective To apply electrical impedance tomography(EIT)technology to assess the lung regional ventilation distribution in patients admitted to the intensive care unit(ICU)after a cardiac surgery,and to analyze its value of predicting patientsshort-term prognosis.Methods Data from 46 patients admitted to ICU after a cardiac surgery from January to November 2023 were retrospectively collected.Using EIT,we assessed the lung regional ventilation of four regions of interest(ROI)and analyzed its influence on patientslength of stay in ICU,mechanical ventilation duration and tracheal intubation duration.Results A total of 46 patients were selected,including 29 males and 17 females,with an average age of(582±95)years.The pa-tients who received a cardiac surgery equal to or over 5 hours had worse ventilation in the dorsal region(ROI 4)(P=0022).The patients with worse dorsal region ventilation(ROI 4<9%)had lower oxygenation index(P=0025),longer mechanical ventilation duration(P=0004),longer tracheal intubation duration(P=0010),and longer ICU stay(P=0018).A larger ROI 4 percent was a protective factor for patientsprognosis(OR=0743,95%CI:0587-0941,P=0014)after controlling for the impact of age,gender,length of surgery and acute physiology and chronic health evaluation(APACHE)score at the admission.With a cutoff value of 95%,ROI 4 had 857%sensitivity and 562%specificity to predict worse prognosis The area under the curve(AUC)was 0752(95%CI:0599-0905,P=0007).Conclusions The length of a car-diac surgery influences patientslung ventilation,which further impacts patientsprognosis.EIT can be used as a bedside tool to assess patientslung ventilation and inform corresponding clinical interventions to improve patientsprognosis.