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中华重症医学电子杂志 ›› 2025, Vol. 11 ›› Issue (04) : 335 -339. doi: 10.3877/cma.j.issn.2096-1537.2025.04.002

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电阻抗成像肺通气影像特征导向心脏外科术后肺部并发症的诊疗策略
宋涛1,,2, 袁思依1, 何怀武1,()   
  1. 1 100730 北京,疑难重症及罕见病国家重点实验室 中国医学科学院北京协和医院重症医学科
    2 300052 天津,天津医科大学总医院重症医学科
  • 收稿日期:2024-09-12 出版日期:2025-11-28
  • 通信作者: 何怀武
  • 基金资助:
    国家重点研发计划项目(2022YFC2404805); 首都医学科技创新成果转化优促计划赋能项目(YC202301QX0024); 国家自然科学基金面上项目(82272249)

Diagnosis and treatment strategy of pulmonary complications after cardiac surgery guided by the EIT lung ventilation imaging features

Tao Song1,,2, Siyi Yuan1, Huaiwu He1,()   

  1. 1 Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, State Key Laboratory of Difficult and Rare Diseases, Beijing 100730, China
    2 Department of Intensive Care Unit, Tianjin Medical University General Hospital, Tianjin 300052, China
  • Received:2024-09-12 Published:2025-11-28
  • Corresponding author: Huaiwu He
引用本文:

宋涛, 袁思依, 何怀武. 电阻抗成像肺通气影像特征导向心脏外科术后肺部并发症的诊疗策略[J/OL]. 中华重症医学电子杂志, 2025, 11(04): 335-339.

Tao Song, Siyi Yuan, Huaiwu He. Diagnosis and treatment strategy of pulmonary complications after cardiac surgery guided by the EIT lung ventilation imaging features[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2025, 11(04): 335-339.

术后肺部并发症(PPC)是心脏外科术后患者面临的最具挑战的并发症之一,是导致术后患者死亡的主要原因。肺电阻抗成像(EIT)作为一种床旁无创肺通气监测技术在重症呼吸管理中的应用与日俱增。近来,有学者发现EIT肺通气影像特征可用于预测腹部外科术后PPC的发生。基于本中心前期EIT应用的临床实践经验,本文总结EIT肺通气影像特征导向的心脏外科术后PPC诊疗策略,以期为EIT技术在心脏外科术后的应用提供参考。

Postoperative pulmonary complications (PPC) are one of the most challenging complications faced by patients after cardiac surgery, and are the major cause of postoperative mortality. Electrical impedance tomography (EIT) is a kind of noninvasive bedside lung ventilation monitoring technology which is used increasingly in intensive respiratory management. Recently, it has been found that EIT lung ventilation imaging features can be used to predict the occurrence of PPC after abdominal surgery. Based on the practical experience of EIT application in our center, this paper summarizes the PPC diagnosis and treatment strategy based on EIT lung ventilation image feature, in order to provide reference for the application of EIT technology in cardiac surgery.

图1 EIT肺通气影像常用ROI分区。图a:“层次”式指按自腹侧到背侧等距的层次分布,用以观察重力及非重力依赖区的不同特性,有助于分析呼气末正压变化、复张操作或俯卧位对重力依赖区肺通气的作用效果;图b:“象限”式指以图像中心为原点进行四象限区域划分,可以对左肺及右肺上、下部的局部特点进行比较分析,比如侧卧位、吸痰和胸腔引流等操作的治疗效果等;图c:“自由”式指在一定图像范围内任意移动并调整4个ROI的尺寸,以重点关注分析某ROI的影像特点 注:EIT为电阻抗成像;ROI为感兴趣区
表1 心脏外科术后PPC患者EIT肺通气影像特征分型
图2 不同心脏外科PPC典型EIT肺通气影像分型对比。图a:病例1,52岁男性行升主动脉置换及主动脉弓置换术,术后EIT(左)提示左下4区通气缺失,肺部CT(右)见左侧胸腔积液伴肺不张。经局部引流、变换体位等治疗后好转。图b:病例2,58岁男性行冠脉搭桥术。术后EIT(左)提示右上肺1区通气缺失,经肺CT(右)证实右侧大量气胸,行胸腔闭式引流术后病情改善。图c:病例3,66岁女性行冠脉搭桥术。术后EIT(左)检查发现左上2区+左下4区通气缺失,CT(右)检查见双侧气胸和双肺多发实变,实变以左肺为重,气管镜下见左肺开口处大量痰液,给予充分吸引后通气改善。图d:病例4,43岁男性行二尖瓣和主动脉瓣置换术、VA-ECMO治疗、二次开胸血栓清除手术。EIT(左)检查显示双下肺3区+4区通气缺失,CT(右)检查提示双下肺实变,经俯卧位通气、肺复张等治疗后病情好转 注:PPC为术后肺部并发症;EIT为电阻抗成像;VA-ECMO静脉-动脉体外膜肺氧合
图3 心脏外科PPC患者EIT肺通气分型诊疗流程 注:PPC为术后肺部并发症;EIT为电阻抗成像;ARDS为急性呼吸窘迫综合征;PEEP为呼气末正压;CTPA为螺旋CT肺动脉造影
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