Santos Susana Aguiar, Wembers Carlos Castelar, Horst Klemens, Pfeifer Roman, Simon Tim-Philipp, Pape Hans-Christoph, Hildebrand Frank, Czaplik Michael, Leonhardt Steffen, Teichmann Daniel
Philips Chair for Medical Information Technology, RWTH Aachen University, Aachen, Germany.
Physiol Meas. 2017 Jul 26;38(8):1542-1560. doi: 10.1088/1361-6579/aa7985.
Lung contusion is the most common lung injury following blunt chest trauma which, in turn, is associated with high mortality rates (Gavelli et al 2002 Eur. Radiol. 12 1273-94). Lung contusion is characterized by hemorrhage and edema with consecutively reduced compliance. Objective and Approach: In this study, unilateral lung contusion and other traumata were induced in 12 pigs by using a bolt gun machine. To investigate the pathophysiological consequences of lung contusion, information on clinical parameters was collected and monitored regularly while animals were additionally monitored with electrical impedance tomography (EIT) before trauma, and at 4, 24, 48 and 72 h after polytrauma.
Statistical analyses showed significant differences between the measurement time points in terms of lung compliance ([Formula: see text]) and in global EIT parameters, such as absolute global impedance (aGlobImp) ([Formula: see text]), tidal impedance variation (TIV) ([Formula: see text]) and the center of ventilation (CoV) ([Formula: see text]). Additionally, distinct analyses for the left (non-injured) and right (injured) lung were also performed. In this context, during the progress of lung contusion, significant changes were found for the injured lung in TIV ([Formula: see text]), global inhomogeneity ([Formula: see text]), regional ventilation delay ([Formula: see text]), CoV ([Formula: see text]) and in regions of non-ventilation (rNoVent) ([Formula: see text]). Furthermore, TIV and rNoVent were capable to differentiate the injured and the contralateral healthy lung at 4 and 24 h after injury (TIV: [Formula: see text] and [Formula: see text]; rNoVent: [Formula: see text] and [Formula: see text]). TIV reached a sensitivity of 82% (specificity of 100%) at 4 h and sensitivity of 82% (specificity of 82%) at 24 h after injury, in detecting lung contusion specific consequences.
The results indicate that EIT might be a valuable tool to detect and to monitor lung injuries including lung contusion. Most probably, EIT-derived indices could also be used to adapt ventilator settings to optimize individual lung protection.
肺挫伤是钝性胸部创伤后最常见的肺部损伤，而钝性胸部创伤又与高死亡率相关（加韦利等人，2002年，《欧洲放射学》12卷，1273 - 1294页）。肺挫伤的特征是出血和水肿，进而导致顺应性连续降低。目的和方法：在本研究中，使用射钉枪在12头猪身上造成单侧肺挫伤和其他创伤。为了研究肺挫伤的病理生理后果，在动物遭受多发伤之前以及多发伤后4、24、48和72小时，定期收集并监测临床参数信息，同时使用电阻抗断层成像（EIT）对动物进行额外监测。
统计分析表明，在肺顺应性（[公式：见原文]）以及EIT全局参数方面，如绝对全局阻抗（aGlobImp，[公式：见原文]）、潮气量阻抗变化（TIV，[公式：见原文]）和通气中心（CoV）（[公式：见原文]），测量时间点之间存在显著差异。此外，还对左（未受伤）肺和右（受伤）肺进行了单独分析。在此背景下，在肺挫伤进展过程中，发现受伤肺在TIV（[公式：见原文]）、全局不均匀性（[公式：见原文]）、区域通气延迟（[公式：见原文]）、CoV（[公式：见原文]）和无通气区域（rNoVent，[公式：见原文]）方面有显著变化。此外，TIV和rNoVent能够在损伤后4小时和24小时区分受伤肺和对侧健康肺（TIV：[公式：见原文]和[公式：见原文]；rNoVent：[公式：见原文]和[公式：见原文]）。在检测肺挫伤的特定后果时，TIV在损伤后4小时达到82%的敏感性（特异性为100%），在损伤后24小时达到82%的敏感性（特异性为82%）。
结果表明，EIT可能是检测和监测包括肺挫伤在内的肺部损伤的有价值工具。很可能，源自EIT的指标也可用于调整呼吸机设置，以优化个体肺保护。
