电阻抗成像技术肺灌注的研究进展

Research Progress of Electrical Impedance Tomography in Lung Perfusion

摘要: 肺泡通气–血流灌注(V/Q)匹配失调是急性呼吸衰竭的核心病理生理机制，其精准评估是重症呼吸疾病诊疗的关键环节。现有V/Q评估的影像学方法例如多惰性气体清除技术、核素显像和CT等，存在辐射暴露、无法床旁连续监测等局限，难以满足重症监护室床旁实时诊疗需求。电阻抗成像技术(Electrical Impedance Imaging Technology, EIT)作为无创、无辐射的床旁功能成像技术，可动态追踪肺通气与灌注的时空分布，检测效能已获多项临床前与临床研究验证，为重症患者V/Q匹配的床旁评估提供了全新方案。本文系统梳理EIT肺灌注成像原理与方法，重点阐述其在急性肺栓塞诊疗、急性呼吸窘迫综合征个体化管理、肺移植术后功能评估等领域的最新研究进展，客观分析技术现存局限性并展望未来发展方向，旨在为该技术的临床标准化应用与重症呼吸精准诊疗提供循证依据。

Abstract: Alveolar ventilation-perfusion (V/Q) mismatch is the core pathophysiological mechanism of acute respiratory failure (ARF), and its accurate assessment serves as a critical link in the diagnosis and management of critical respiratory diseases. Existing modalities for V/Q assessment, including the multiple inert gas elimination technique (MIGET), as well as imaging methods such as radionuclide imaging and computed tomography (CT), have inherent limitations including ionizing radiation exposure and the inability to perform continuous bedside monitoring, which renders them difficult to meet the requirements of real-time bedside diagnosis and treatment in the intensive care unit (ICU). Electrical Impedance Tomography (EIT), as a non-invasive, radiation-free bedside functional imaging modality, can dynamically track the spatiotemporal distribution of pulmonary ventilation and perfusion. Its detection performance has been validated by numerous preclinical and clinical studies, providing a novel solution for the bedside assessment of V/Q matching in critically ill patients. This review systematically summarizes the principles and methodologies of EIT-based lung perfusion imaging, and focuses on the latest research advances in its clinical applications, including the diagnosis and treatment of acute pulmonary embolism (APE), individualized management of acute respiratory distress syndrome (ARDS), and postoperative functional evaluation after lung transplantation. It also objectively analyzes the existing limitations of the technology and prospects its future development directions, aiming to provide evidence-based references for the standardized clinical application of this technology and the precise diagnosis and management of critical respiratory diseases.