EIT技术在腹内高压患者机械通气中的应用研究进展

Research Progress of EIT Technique in Mechanical Ventilation of Patients with Intra-Abdominal Hypertension

摘要: 电阻抗断层成像技术(Chest electrical impedance tomography, EIT)是近几年来发展起来的一门实现床旁成像的技术，它具有无辐射性、无创性、灵活性、易操作性等优点，实现了呼吸的可视化以及床旁呼吸管理个性化。本文主要阐述了电阻抗断层成像技术的发展、基本原理，就因重症急性胰腺炎、腹部疾患等导致腹内高压患者在机械通气中的应用进行介绍，有助于临床医生掌握该技术应用，从而根据患者的疾病情况适时地采用电阻抗成像技术，对疾病的发生、发展及时做出实时评估，提高临床医生的工作效率，促进医疗水平的进一步的提高。腹腔内高压(Intra-abdominal hypertension, IAH)是指腹腔内压力(Intra-abdominal pressure, IAP)持续≥12 mmHg，其发病率很高，但全世界的重症监护医生仍然没有充分认识到这一点。有相关研究指出约1/4到1/3的患者在入院时会出现IAH，而1/2的患者会在重症监护病房住院的第1周内就出现IAH。IAH与高发病率和死亡率较高。尽管在过去几十年中取得了相当大的进展，但关于IAH患者的最佳通气管理仍存在一些重要问题。在重症监护期间，监测呼吸功能和调整通气设置非常重要，以IAH存在的情况下，肺在较高的闭合压力下在呼气时会塌陷，不合适的PEEP会给患者带来伤害，过低的PEEP并不能阻止肺塌陷，而过高的PEEP会使肺区域过度膨胀造成肺损伤。因此在密切监测氧合和血流动力学反应的同时，PEEP的设置也需要着重关注的目标，为肺内高压患者的肺保护性通气保驾护航。但是近几年的相关研究发现这类患者的最佳PEEP的设置仍然未知。随着EIT技术逐渐发展成熟，在急性呼吸窘迫综合征(Acute distress syndrome, ARDS)最佳PEEP设置中的应用研究越来越多，是否可以将EIT技术应用于腹内高压(IAH)患者中呢？本文就将介绍EIT技术在腹内高压患者中的应用研究。

Abstract: Chest Electrical Impedance tomography EIT is a technology developed in recent years to realize bedside imaging. It has many advantages, such as radiation-free, non-invasive, flexible and easy to operate, and can realize visualization of respiration and personalized beside respiratory manage-ment. This article mainly elaborates on the development of electrical impedance tomography im-aging technology, basic principle, is caused by severe acute pancreatitis, abdominal diseases such as internal pressure in the application of mechanical ventilation in patients with, help clinical doctors to master the technical application, and according to the patient’s disease situation timely the use of electrical impedance imaging technology, real-time evaluation to the occurrence and development of disease in time, improve the work efficiency of clinicians, promote the further improvement of level. Intra-abdominal hypertension IAH, defined as intra-abdominal pressure IAP that persists for ≥12 mmHg, is highly prevalent but still not fully recognized by intensive care physicians worldwide. Studies have shown that approximately one-quarter to one-third of patients develop IAH on admis-sion, and one-half of patients develop IAH within the first week of admission to the intensive care unit. IAH is associated with higher morbidity and mortality. Despite considerable progress over the past decades, important questions remain regarding the optimal ventilation management of IAH patients. During the period of intensive care, it is very important to monitor respiratory function and adjust ventilation settings. In the presence of IAH, the lungs will collapse during exhalation under high closure pressure, and inappropriate PEEP will bring harm to patients. Too low PEEP cannot prevent lung collapse, while too high PEEP will cause excessive expansion of the lung area and lung injury. Therefore, while closely monitoring oxygenation and hemodynamic response, the setting of PEEP also needs to focus on the target, to protect lung protective ventilation for patients with intrapulmonary hypertension. However, recent studies have found that the optimal PEEP set-ting for such patients is still unknown. With the gradual development and maturity of EIT technol-ogy, there are more and more studies on the application of EIT technology in the setting of the op-timal PEEP in acute respiratory distress syndrome ARDS. Can EIT technology be applied in patients with intra-abdominal hypertension (IAH)? This article will introduce the application of EIT tech-nology in patients with intra-abdominal hypertension.