分层电阻抗成像技术监测自主呼吸试验失败的脑干肿瘤术后患者的呼吸“钟摆现象”

Pendelluft in the brainstem tumor patients with failed spontaneous breathing test monitored by electrical impedance tomography

目的采用分层电阻抗成像(electrical impedance tomography,EIT)技术监测自主呼吸试验失败脑干肿瘤术后患者的呼吸“钟摆现象”。方法总结分析了1例延髓、桥脑及桥前池区肿瘤切除术后患者反复自主呼吸试验失败的血气分析、EIT图像和“钟摆现象”,并进行相关分析及文献复习。结果患者女性,60岁,以“吞咽困难、口齿不清”入院,确诊延髓、桥脑及桥前池区肿瘤后行颅底占位切除术,术后转入重症医学科继续治疗。随着病情的稳定,反复尝试自主呼吸试验失败,脱机后二氧化碳分压(partial pressure of carbon dioxide,PaCO_(2))升高,考虑继发性中枢性通气不足,行EIT监测后发现,在支持压力(pressure support,PS)为0 cmH 2O和4 cmH 2O时出现了呼吸“钟摆现象”,PS增加至8 cmH 2O时无“钟摆现象”。经历长时间的呼吸锻炼,患者最终历时61 d脱机成功出院。结论脑干肿瘤术后患者因继发性中枢性通气不足致反复自主呼吸试验失败,应用EIT技术能够监测到该患者肺内通气存在呼吸“钟摆现象”,这可能是PaCO_(2)增高的其中原因之一,但仍需要更多的研究加以证实。

Objective To monitor the occurrence of"pendelluft"in the patients with brainstem tumor with failed spontaneous breathing test by electrical impedance tomography(EIT).Methods Blood gas analysis,EIT image and"pendelluft"of a patient who failed in repeated spontaneous breathing test after resection of bulbar,pontine and anterior pon cistern tumor were summarized,and related analysis as well as literature review were carried out.Results The patients was female and 60 years old,and was admitted to hospital with"complaints of slurred speech,difficulty in swallowing".After diagnosis of bulbar,pontine and anterior pon cistern tumor,the excision of the brainstem tumor was performed,and the patient was transferred to intensive care unit for further treatment.With the stabilization of the disease,repeated attempts of spontaneous breathing test failed,and the partial pressure of carbon dioxide(PaCO_(2))increased after weaning from ventilator.Considering secondary central hypoventilation,EIT showed that the respiratory"pendelluft"appeared when pressure support(PS)was set at 0 cmH 2O and 4 cmH 2O.There was no"pendelluft"when PS increased to 8 cmH 2O.After a long period of breathing exercises,the patient finally succeeded in spontaneous breathing and discharged after 61 days.Conclusions In the patients with brainstem tumor,repeated spontaneous breathing tests fail due to secondary central hypoventilation.The use of EIT technology can detect the respiratory"pendelluft"in this patient,which may be one of the reasons for the increase in PaCO_(2),but more studies are needed.