CN111449657A - Bedside pulmonary ventilation-blood flow perfusion electrical impedance tomography method based on saline angiography - Google Patents

Bedside pulmonary ventilation-blood flow perfusion electrical impedance tomography method based on saline angiography Download PDF

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CN111449657A
CN111449657A CN202010296273.0A CN202010296273A CN111449657A CN 111449657 A CN111449657 A CN 111449657A CN 202010296273 A CN202010296273 A CN 202010296273A CN 111449657 A CN111449657 A CN 111449657A
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何怀武
隆云
招展奇
池熠
袁思依
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Abstract

本发明公开了一种床旁的基于盐水造影肺通气‑血流灌注电阻抗断层成像方法。另外,本发明还公开了基于上述方法的图像监测装置、图像监测系统、肺栓塞诊断系统。本发明的方法提高了血流灌注成像质量,并以此计算出死腔通气%,肺内分流%,区域性通气‑血流匹配%,更具实用性。利用本发明的方法可以诊断肺栓塞,敏感性90.9%,特异性98.6%,具有很高的临床应用价值。

Figure 202010296273

The invention discloses a bedside lung ventilation-blood flow perfusion electrical impedance tomography imaging method based on saline contrast. In addition, the present invention also discloses an image monitoring device, an image monitoring system and a pulmonary embolism diagnosis system based on the above method. The method of the invention improves the imaging quality of blood perfusion, and calculates the dead space ventilation %, the intrapulmonary shunt %, and the regional ventilation-blood flow matching %, which is more practical. The method of the present invention can diagnose pulmonary embolism with a sensitivity of 90.9% and a specificity of 98.6%, and has high clinical application value.

Figure 202010296273

Description

一种床旁的基于盐水造影肺通气-血流灌注电阻抗断层成像 方法A point-of-care saline-based pulmonary ventilation-perfusion electrical impedance tomography method

技术领域technical field

本发明属于临床医学领域,具体涉及一种床旁的基于盐水造影肺通气-血流灌注电阻抗断层成像方法。The invention belongs to the field of clinical medicine, and in particular relates to a bedside lung ventilation-blood flow perfusion electrical impedance tomography imaging method based on saline angiography.

背景技术Background technique

电阻抗断层成像(EIT)技术是一种用于研究和检测人类和动物中区域肺通气和灌注(血液流动)的非侵入性成像技术。与常规方法相反,EIT不需要患者通过管道或传感器呼吸,不应用电离X射线,并且可以用于长时间,例如24小时或甚至更长时间。因此,EIT可以连续使用,因此适合于实时和长期监测治疗效果。EIT于1983年首次用于监测呼吸功能,并保持允许肺容积、血流量和心脏活动的区域变化的连续的、非侵入性检测的唯一的床边方法。该技术的更多细节可以在“Electrical impedance tomography"by Costa E.L.,LimaR.G.,and Amato M.B.in Curr Opin Crit Care,Feb.2009,15(1),p.18-24中找到。Electrical impedance tomography (EIT) is a non-invasive imaging technique used to study and detect regional lung ventilation and perfusion (blood flow) in humans and animals. Contrary to conventional methods, EIT does not require the patient to breathe through a tube or sensor, does not apply ionizing X-rays, and can be used for extended periods of time, such as 24 hours or even longer. Therefore, EIT can be used continuously and is therefore suitable for real-time and long-term monitoring of treatment effects. EIT was first used to monitor respiratory function in 1983 and remains the only bedside method that allows continuous, non-invasive detection of regional changes in lung volumes, blood flow, and cardiac activity. More details of this technique can be found in "Electrical impedance tomography" by Costa E.L., Lima R.G., and Amato M.B. in Curr Opin Crit Care, Feb. 2009, 15(1), p.18-24.

在EIT中,如美国专利US5626146所披露的,多个电极,通常从8到32个,设置在要检查的身体的表面上。控制单元确保电信号,例如电流施加在皮肤上的一对或多对电极以形成电场,其反过来由其它电极检测。用于施加电流的电极称为“电流注入电极”,尽管其中一个可能作为基准电位,例如接地。通常情况下,3至10mARMS在0.1-1000kHz的频率范围内注入。采用剩余的电极,检测所产生的电压(形成“EIT数据向量”或“扫描帧”)并随后用于估计身体中电阻抗的分布。具体的算法得到开发以将一组电压转换成图像。In EIT, as disclosed in US Pat. No. 5,626,146, a plurality of electrodes, typically from 8 to 32, are placed on the surface of the body to be examined. The control unit ensures that electrical signals, such as current, are applied to one or more pairs of electrodes on the skin to form an electric field, which in turn is detected by the other electrodes. The electrodes used to apply the current are called "current injection electrodes", although one of them may serve as a reference potential, such as ground. Typically, 3 to 10 mARMS is injected in the frequency range of 0.1-1000kHz. Using the remaining electrodes, the resulting voltage is detected (forming an "EIT data vector" or "scan frame") and subsequently used to estimate the distribution of electrical impedance in the body. Specific algorithms are developed to convert a set of voltages into an image.

目前基于电阻抗技术(EIT)的床旁肺血管灌注成像质量较差,受到心脏跳动、肺血管搏动等电阻信号的干扰,在临床上应用性差。为了提高成像质量,有研究开发了盐水造影技术电阻抗成像技术方法,通过中心静脉导管注射盐水,同时呼吸暂停,采集胸腔电阻信号的变化,建立盐水造影的局部电阻-时间变化曲线,但电阻-时间曲线分析方法种类较多,在注射盐水过程中,识别盐水到达右心房,减少电阻信号容易干扰,影响成像分析,获取准确的盐水首次到时肺时间点是一难题,目前有学者通过同时评估,某一区域肺区电阻下降和心脏电阻下降的时间的不一致来确定,但实用性差和费时。At present, bedside pulmonary vascular perfusion imaging based on electrical impedance technology (EIT) is of poor quality and is interfered by electrical resistance signals such as heart beating and pulmonary vascular beating, so it has poor clinical applicability. In order to improve the imaging quality, some studies have developed a saline angiography electrical impedance imaging technique. Saline is injected through a central venous catheter, while apnea is stopped, the changes in the thoracic resistance signal are collected, and the local resistance-time curve of saline angiography is established, but the resistance- There are many types of time curve analysis methods. In the process of saline injection, it is difficult to identify the arrival of saline to the right atrium to reduce the interference of resistance signals and affect imaging analysis. It is a difficult problem to obtain the accurate lung time point when saline first arrives. , the inconsistency of the time of the decrease in the resistance of the lung area and the decrease of the cardiac resistance in a certain area, but the practicability is poor and time-consuming.

床旁肺血流灌注成像分析,目前电阻抗技术多集中的在通气和血流的分布百分比,属于半定量评估,在技术上难以深入到通气死腔、肺内分流的等量化计算。For bedside pulmonary blood perfusion imaging analysis, the current electrical impedance technology mostly focuses on the distribution percentage of ventilation and blood flow, which belongs to semi-quantitative evaluation, and it is technically difficult to go deep into the quantitative calculation of ventilation dead space and intrapulmonary shunt.

本申请旨在在解决床旁电阻抗肺血流灌注成像的技术难题,提高准确度和应用价值。The purpose of this application is to solve the technical problems of bedside electrical impedance pulmonary blood perfusion imaging, and to improve the accuracy and application value.

发明内容SUMMARY OF THE INVENTION

技术问题technical problem

本发明的目的之一在于提供了一种床旁的基于盐水造影肺通气-血流灌注电阻抗断层成像方法。One of the objectives of the present invention is to provide a bedside pulmonary ventilation-perfusion electrical impedance tomography imaging method based on saline contrast.

本发明的目的之二在于提供一种图像监测装置。Another object of the present invention is to provide an image monitoring device.

本发明的目的之三在于提供一种图像监测系统。The third object of the present invention is to provide an image monitoring system.

本发明的目的之四在于提供一种肺栓塞的诊断方法和诊断系统。The fourth object of the present invention is to provide a diagnostic method and a diagnostic system for pulmonary embolism.

技术方案Technical solutions

根据本发明的一个方面,本发明提供了一种床旁的基于盐水造影肺通气-血流灌注电阻抗断层成像方法。所述方法包括如下步骤:According to one aspect of the present invention, the present invention provides a bedside-based saline contrast pulmonary ventilation-perfusion electrical impedance tomography method. The method includes the following steps:

(1)呼吸屏气测试,要求最少8秒以上;(1) Breath-hold test, which requires at least 8 seconds;

(2)注射盐水进行肺血流灌注造影,持续采集胸部电阻抗信号的变化;(2) Pulmonary blood perfusion angiography was performed by injecting saline, and the changes of the electrical impedance signal of the chest were continuously collected;

(3)对电阻信号数据进行离线分析。(3) Offline analysis of resistance signal data.

步骤(1)的具体操作如下:呼吸屏气测试,要求最少8秒以上(呼吸机机械通气时,按呼气或吸气屏气按键10s;自主呼吸患者嘱屏气8秒);呼吸屏气测试通过后,方可行盐水造影EIT检查。The specific operations of step (1) are as follows: the breath-hold test requires at least 8 seconds (when the ventilator is mechanically ventilated, press the exhale or inspiratory breath-hold button for 10s; spontaneously breathing patients are asked to hold their breath for 8 seconds); after the breath-hold test is passed, Before performing saline angiography EIT examination.

本发明的注射盐水的浓度为10%,注射量为10ml。The concentration of the injection saline of the present invention is 10%, and the injection volume is 10ml.

步骤(2)的具体操作如下:受试者连接肺电阻抗监测仪器,准备10%NaCl10ml,确认受试者已建立中心静脉导管;呼吸屏气开始后,从中心静脉导管注射10%NaCl 10ml到体内进行肺血流灌注造影;注射盐水前2分钟开始持续采集胸部电阻抗信号的变化。The specific operation of step (2) is as follows: the subject is connected to the pulmonary electrical impedance monitoring instrument, prepare 10% NaCl 10ml, and confirm that the subject has established a central venous catheter; after the breath-holding starts, inject 10% NaCl 10ml into the body from the central venous catheter Pulmonary perfusion angiography was performed; changes in electrical impedance signals of the chest were continuously collected starting 2 minutes before saline injection.

步骤(3)对电阻信号数据进行离线分析包括:The off-line analysis of the resistance signal data in step (3) includes:

a、构建肺血流灌注图像;a. Construct pulmonary blood perfusion image;

b、构建肺通气图像;b. Construct lung ventilation images;

c、构建肺通气/血流分布图像。c. Construct lung ventilation/blood flow distribution images.

步骤a中构建肺血流灌注图像的具体操作如下:屏气期间整体电阻曲线开始下降作为盐水进入体内的起点(T0),一个心动周期后作为盐水进入肺血管的起点(T1),整体电阻的最低点作为盐水通过肺血管的终点(T2),T0-T1时间段的电阻曲线反映盐水进入右心,不反映肺血管灌注,为减少干扰,分析中不予采纳该时段的曲线;应用T1-T2时间段的各个肺区域的电阻-时间变化曲线(斜率拟合)进行构建。The specific operation of constructing a pulmonary blood perfusion image in step a is as follows: the overall resistance curve begins to drop during breath-holding as the starting point for saline to enter the body (T0), and after one cardiac cycle as the starting point for saline to enter the pulmonary blood vessels (T1), the lowest overall resistance point as the end point of saline passing through the pulmonary vessels (T2). The resistance curve of the T0-T1 time period reflects the saline entering the right heart and does not reflect the pulmonary vascular perfusion. To reduce interference, the curve of this period is not used in the analysis; T1-T2 is used. A resistance-time curve (slope fit) of each lung region over time periods was constructed.

步骤b中构建肺通气图像的具体操作如下:通过注射前1分钟内至少5个连续的呼吸周期的肺电阻变化进行肺通气图像构建。The specific operation of constructing the lung ventilation image in step b is as follows: the lung ventilation image is constructed by the lung resistance changes of at least 5 consecutive breathing cycles within 1 minute before the injection.

步骤c中构建肺通气/血流分布图像的具体操作如下:肺通气图像和肺血流灌注图像以最大像素点的20%做阈值构建肺通气/血流分布图像。The specific operations for constructing the lung ventilation/blood flow distribution image in step c are as follows: the lung ventilation image and the pulmonary blood flow perfusion image use 20% of the maximum pixel points as a threshold to construct the lung ventilation/blood flow distribution image.

根据本发明的另一个方面,本发明提供了一种图像监测装置,所述装置包括数据接收器,图像处理器和控制器。According to another aspect of the present invention, the present invention provides an image monitoring apparatus including a data receiver, an image processor and a controller.

所述数据接收器负责接收基于肺电阻抗监测仪器测定的肺通气阻抗数据、肺血液灌注阻抗数据。The data receiver is responsible for receiving lung ventilation impedance data and lung blood perfusion impedance data determined based on the lung electrical impedance monitoring instrument.

所述图像处理器负责将肺通气阻抗数据、肺血液灌注阻抗数据生成肺通气图像、肺血液灌注图像。所述图像处理器根据前面所述的方法将阻抗数据生成图像。The image processor is responsible for generating a lung ventilation image and a lung blood perfusion image from the lung ventilation impedance data and the lung blood perfusion impedance data. The image processor generates an image from the impedance data according to the method previously described.

所述控制器负责根据屏幕模式和测量部位控制显示肺通气图像、肺血液灌注图像中的至少一个。The controller is responsible for controlling and displaying at least one of a lung ventilation image and a lung blood perfusion image according to the screen mode and the measurement site.

控制器可包括图像和波形输出控制模块、阻抗测量控制模块,和信息确定和传输模块。The controller may include an image and waveform output control module, an impedance measurement control module, and an information determination and transmission module.

图像和波形输出控制模块可配置为根据预设的屏幕模式或想要监测的对象的测量部位来控制显示肺通气图像、肺血流灌注阻抗图像和肺通气/血流分布图像中的至少一个。The image and waveform output control module may be configured to control to display at least one of a lung ventilation image, a lung blood perfusion impedance image, and a lung ventilation/blood flow distribution image according to a preset screen mode or a measurement site of an object to be monitored.

测量部位可以指关于对象的肺部、心脏中的至少一个的状态更准确监测的部位。The measurement site may refer to a site that is more accurately monitored with respect to the state of at least one of the subject's lungs and heart.

屏幕模式可包括基于对象的某个病理状态划分的多个屏幕区域以显示肺通气图像、肺血流灌注阻抗图像和肺通气/血流分布图像中的至少一个。The screen mode may include a plurality of screen areas divided based on a certain pathological state of the subject to display at least one of a lung ventilation image, a lung blood perfusion impedance image, and a lung ventilation/blood flow distribution image.

阻抗测量控制模块可配置为控制电阻抗监测仪器测量对象胸部处的肺通气阻抗数据、肺血流灌注阻抗数据。The impedance measurement control module may be configured to control the electrical impedance monitoring instrument to measure lung ventilation impedance data and pulmonary blood flow perfusion impedance data at the chest of the subject.

信息确定和传输模块可配置为控制由数据接收器和图像处理器实施的特征,并将所接收到的肺通气阻抗数据、肺血流灌注阻抗数据、传输给图像处理器,以使得肺通气阻抗数据、肺血流灌注阻抗数据能够生成为图像。The information determination and transmission module may be configured to control the features implemented by the data receiver and the image processor, and to transmit the received lung ventilation impedance data, pulmonary blood flow perfusion impedance data, to the image processor such that the lung ventilation impedance The data, pulmonary perfusion impedance data, can be generated as an image.

而且,信息确定和传输模块可配置为控制将所接收的肺通气阻抗数据、肺血流灌注阻抗数据、和所生成的肺通气阻抗图像、肺血流灌注阻抗图像中的至少一个传输到外部。Also, the information determination and transmission module may be configured to control transmission of at least one of the received lung ventilation impedance data, pulmonary blood perfusion impedance data, and the generated lung ventilation impedance image, pulmonary blood perfusion impedance image to the outside.

根据本发明的又一个方面,本发明提供了一种图像监测系统,所述系统包括前面所述的图像监测装置。According to yet another aspect of the present invention, the present invention provides an image monitoring system, which includes the aforementioned image monitoring device.

进一步,所述系统还可以包括肺电阻抗监测仪器。所述肺电阻抗监测仪器负责测定肺通气阻抗数据、肺血液灌注阻抗数据。Further, the system may also include a lung electrical impedance monitoring instrument. The lung electrical impedance monitoring instrument is responsible for measuring lung ventilation impedance data and lung blood perfusion impedance data.

根据本发明的又一个方面,本发明提供一种肺栓塞的诊断方法,所述方法包括利用前面所述的方法构建肺通气/血流分布图像,计算死腔通气%(只有通气但无血流灌注的区域在总区域的百分比),当死腔通气%>30.37%诊断为肺栓塞。According to yet another aspect of the present invention, the present invention provides a method for diagnosing pulmonary embolism, the method comprising constructing an image of pulmonary ventilation/blood flow distribution using the aforementioned method, calculating % dead space ventilation (only ventilation but no blood flow) Perfusion of the area in the percentage of the total area), when the dead space ventilation%> 30.37% diagnosed as pulmonary embolism.

根据本发明的又一个方面,本发明提供了一种肺栓塞诊断系统,所述诊断系统包括诊断装置,所述诊断装置运行前面所述的诊断方法。According to yet another aspect of the present invention, the present invention provides a pulmonary embolism diagnosis system, the diagnosis system comprising a diagnosis apparatus, and the diagnosis apparatus operates the aforementioned diagnosis method.

优选地,所述系统还包括前面所述的图像监测装置。Preferably, the system further comprises the aforementioned image monitoring device.

更优选地,所述系统还包括肺电阻抗监测仪器。More preferably, the system further includes a lung electrical impedance monitoring instrument.

肺栓塞是指各种栓子进入肺循环阻塞肺动脉或其他分支引起肺循环障碍的临床和病理生理综合症,它包括肺血栓栓塞、脂肪栓综合症、羊水栓塞、空气栓塞等。Pulmonary embolism refers to a clinical and pathophysiological syndrome in which various emboli enter the pulmonary circulation and block the pulmonary artery or other branches and cause pulmonary circulation disorders. It includes pulmonary thromboembolism, fat embolism syndrome, amniotic fluid embolism, and air embolism.

技术效果technical effect

本发明的方法中通气去除一个心动周期的电阻信号有效低减少心脏的干扰,可靠地识别盐水照影剂首次到达肺区的时间节点,并可最大可能保持原有的肺区域。In the method of the present invention, ventilation removes the resistance signal of one cardiac cycle, effectively reducing the interference of the heart, reliably identifying the time node when the saline contrast agent first reaches the lung area, and maintaining the original lung area to the greatest extent possible.

本发明的方法中提出试验前-需要呼吸屏气评估,提高血流分布评估的有效率。In the method of the present invention, it is proposed that breath-hold assessment is required before the test, which improves the efficiency of blood flow distribution assessment.

本发明的方法中经过筛选确定了20%的阈值,提高血流灌注成像的质量,并以此计算出死腔通气%,肺内分流%,区域性通气-血流匹配%(V/Q Macth%),更具实用性。In the method of the present invention, a threshold of 20% is determined through screening to improve the quality of blood perfusion imaging, and based on this, the percentage of dead space ventilation, % of intrapulmonary shunt, and % of regional ventilation-blood flow matching (V/Q Macth %), which is more practical.

利用本发明的方法可以诊断肺栓塞,敏感性90.9%,特异性98.6%,具有很高的临床应用价值。The method of the present invention can diagnose pulmonary embolism with a sensitivity of 90.9% and a specificity of 98.6%, and has high clinical application value.

附图说明Description of drawings

图1显示电阻抗-时间曲线图;Figure 1 shows a graph of electrical impedance versus time;

图2显示右心图像和肺血流灌注图像,其中A:右心图像;B:肺血流灌注图像;Figure 2 shows the right heart image and pulmonary blood perfusion image, wherein A: right heart image; B: pulmonary blood perfusion image;

图3显示ROC曲线图;Figure 3 shows the ROC curve;

图4显示肺栓塞患者A的肺部图像,其中A:肺血管CT造影;B:肺通气图像;C:肺血流灌注图像;D:肺通气/血流分布图像;Figure 4 shows lung images of patient A with pulmonary embolism, wherein A: CT angiography of pulmonary angiography; B: image of pulmonary ventilation; C: image of pulmonary blood perfusion; D: image of pulmonary ventilation/blood flow distribution;

图5显示血胸患者B的肺部图像,其中A:肺CT造影;B:肺通气图像;C:肺血流灌注图像;D:肺通气/血流分布图像。Figure 5 shows lung images of patient B with hemothorax, wherein A: lung CT angiography; B: lung ventilation image; C: pulmonary blood perfusion image; D: lung ventilation/blood flow distribution image.

具体实施方式Detailed ways

在进一步描述本发明具体实施方式之前,应理解,本发明的保护范围不局限于下述特定的具体实施方案;还应当理解,本发明实施例中使用的术语是为了描述特定的具体实施方案,而不是为了限制本发明的保护范围。下列实施例中未注明具体条件的试验方法,通常按照常规条件,或者按照各制造商所建议的条件。Before further describing the specific embodiments of the present invention, it should be understood that the protection scope of the present invention is not limited to the following specific specific embodiments; it should also be understood that the terms used in the examples of the present invention are for describing specific specific embodiments, It is not intended to limit the protection scope of the present invention. In the following examples, the test methods without specific conditions are usually in accordance with conventional conditions or in accordance with the conditions suggested by various manufacturers.

实施例 肺通气/血流分布图像构建与联合分析Example Construction and joint analysis of lung ventilation/blood flow distribution images

测量病例与数据采集Measuring Cases and Data Collection

本研究经本单位伦理委员会通过。入组标准为临床诊断呼吸衰竭患者,且已经建立中心静脉导管注射药物治疗。排除标准胸部畸形或行电阻抗监测存在禁忌(局部皮肤损害)。This study was approved by the ethics committee of our institution. The inclusion criteria were patients with clinically diagnosed respiratory failure and established central venous catheter injection drug therapy. Exclusion criteria for chest deformity or contraindications to electrical impedance monitoring (local skin lesions).

患者信息:33名女性,50名男性,平均年龄62岁,大部分是呼吸衰竭患者。Patient information: 33 women, 50 men, mean age 62 years, mostly patients with respiratory failure.

EIT原始数据由PulmoVista 500(

Figure BDA0002452304160000061
Lübeck,Germany)采集,包含16个感应电极的EIT电极带放置于患者第四至第六肋间,参考电极置于腹部。电流激励模式为相邻激励模式,单幅EIT图像含有32×32个像素,每秒包含20帧图像。EIT图像的后续处理基于MATLABR2015b(Mathworks,Natick,Massachusetts,USA)。EIT raw data by PulmoVista 500 (
Figure BDA0002452304160000061
Lübeck, Germany) acquisition, the EIT electrode strip containing 16 sensing electrodes was placed in the fourth to sixth intercostal space of the patient, and the reference electrode was placed in the abdomen. The current excitation mode is adjacent excitation mode, a single EIT image contains 32 × 32 pixels, and contains 20 images per second. Subsequent processing of EIT images was based on MATLABR2015b (Mathworks, Natick, Massachusetts, USA).

首先,呼吸屏气测试,要求最小8秒以上(呼吸机机械通气时,先予适当镇静,调整呼吸机为完全控制通气模式,按呼气或吸气屏气按键10s;自住呼吸患者嘱屏气8秒);呼吸屏气测试通过后,方可行盐水造影EIT检查。First, the breath-hold test requires a minimum of 8 seconds (when the ventilator is mechanically ventilated, appropriate sedation first, adjust the ventilator to the fully controlled ventilation mode, press the exhale or inspiratory breath-hold button for 10s; self-restrained breathing patients are instructed to hold their breath for 8 seconds ); after the breath-hold test is passed, saline contrast EIT examination can be performed.

然后,病人连接肺电阻抗监测仪器,准备10%NaCl 10ml,确认患者已建立中心静脉导管(颈内静脉或锁骨下静脉导管均可)。3)盐水注射:一般要求2位操作者一起完成,其中一位在确认EIT机器工作正常,启动患者呼吸屏气同时,发号注射盐水的指令;另外一位操作者得到确认指令后,即刻从中心静脉导管快速注射10%NaCL 10ml到患者体内;在整个操作期间EIT监测仪开启记录模式,在注射盐水前2分钟开始持续采集胸部电阻抗信号数据,全过程要求至少持续5分钟,完整记录屏气期间注射盐水导致肺电阻下降的过程。再次,对电阻信号数据离线分析,分析步骤如下:Then, the patient is connected to the pulmonary electrical impedance monitoring instrument, prepare 10ml of 10% NaCl, and confirm that the patient has established a central venous catheter (internal jugular vein or subclavian vein catheter can be used). 3) Saline injection: Generally, 2 operators are required to complete it together. One of them confirms that the EIT machine is working normally and starts the patient's breath-holding and simultaneously issues a command to inject saline; Rapidly inject 10ml of 10% NaCl into the patient through an intravenous catheter; the EIT monitor turns on the recording mode during the entire operation, and continuously collects chest electrical impedance signal data 2 minutes before the injection of saline. The whole process requires at least 5 minutes, and the breath-holding period is completely recorded. The process by which injection of saline results in a decrease in lung resistance. Again, offline analysis of the resistance signal data, the analysis steps are as follows:

1、屏气期间整体电阻曲线开始下降作为盐水进入体内的起点(T0),一个动周期后作为盐水进入肺血管的起点(T1),整体电阻的最低点作为盐水通过肺血管的终点(T2),T0-T1时间段的电阻曲线反映盐水进入右心,不反映肺血管灌注,为减少干扰,分析中不予采纳该时段的曲线;应用T1-T2时间段的各个肺区域的电阻-时间变化曲线(斜率拟合)进行肺血流灌注图像构建(图1和图2);肺血流灌注图像的建构如下:1. During the breath-holding period, the overall resistance curve begins to decrease as the starting point of saline entering the body (T0), and after one motion cycle, it acts as the starting point for saline entering the pulmonary blood vessels (T1), and the lowest point of the overall resistance acts as the end point (T2) for the saline passing through the pulmonary vessels. The resistance curve in the T0-T1 time period reflects the saline entering the right heart and does not reflect the pulmonary vascular perfusion. In order to reduce interference, the curve of this time period is not used in the analysis; the resistance-time change curve of each lung region in the T1-T2 time period is used. (Slope fitting) to construct the pulmonary blood perfusion image (Figure 1 and Figure 2); the pulmonary blood perfusion image is constructed as follows:

(1)第i个像素点灌注量计算ΔZi(t)=ait+b,t时间,为采纳分析的区域性电阻-时间曲线时间段,ai拟合曲线斜率,局部斜率可以反映灌注量的大小;(1) Calculate the perfusion volume of the i-th pixel point ΔZ i (t)=a i t+b, time t is the time period of the regional resistance-time curve for the analysis, a i is the slope of the fitting curve, and the local slope can reflect the The size of the perfusion volume;

(2)肺灌注图像分布图公式(2) Lung perfusion image distribution map formula

Figure BDA0002452304160000071
Figure BDA0002452304160000071

其中ag*为第g个像素点的相对肺灌注量,a为区域电阻的拟合直线的斜率;N为肺区的像素点总数。所得相对肺灌注分布图像,每个像素的灌注量占总灌注量的百分比;where a g * is the relative lung perfusion volume of the gth pixel, a is the slope of the fitted line of the regional resistance; N is the total number of pixels in the lung area. The obtained relative lung perfusion distribution image, the perfusion volume of each pixel as a percentage of the total perfusion volume;

2、通过注射前1分钟内至少5个连续的呼吸周期的肺电阻变化进行肺通气图像构建;肺通气图像的建构公式如下:2. The lung ventilation image is constructed by the lung resistance changes of at least 5 consecutive breathing cycles within 1 minute before injection; the construction formula of the lung ventilation image is as follows:

Figure BDA0002452304160000072
Figure BDA0002452304160000072

其中Vi为通气图线的总像素点,N纳入的呼吸周期数量;ΔZi,Ins为吸气相对电阻变化,ΔZi,Exp为呼气相对电阻变化;Among them, Vi is the total pixel points of the ventilation graph, and the number of breathing cycles included in N; ΔZ i , Ins is the relative resistance change in inspiration, ΔZ i , Exp is the relative resistance change in exhalation;

3、经过优选0-40%阈值,确定了肺通气图像和肺血流图像以最大像素点的20%做阈值构建肺通气/血流分布图像;具体公式如下:3. After optimizing the 0-40% threshold, it is determined that the lung ventilation image and the pulmonary blood flow image are used as the threshold of 20% of the maximum pixel point to construct the lung ventilation/blood flow distribution image; the specific formula is as follows:

Vk>20%×max(VK), K∈[1,1024]V k >20%×max(V K ), K∈[1,1024]

K定义为局部具有通气的像素点,K is defined as a pixel with local ventilation,

Pg>20%×max(PG), G∈[1,1024]P g >20%×max(P G ), G∈[1,1024]

g定义为局部具有灌注的像素点;g is defined as a pixel with local perfusion;

4、肺通气图和血流灌注分布区域拟合分析获得通气-血流的联合参数:4. The combined parameters of ventilation and blood flow are obtained by fitting analysis of lung ventilation map and blood perfusion distribution area:

死腔通气%:只有通气但无血流灌注的区域在总区域的百分比;Dead space ventilation %: the percentage of the total area that is only ventilated but not perfused;

肺内分流%:只有血流灌注但无通气的区域在总区域的百分比;Intrapulmonary shunt %: the percentage of the total area that is only perfused but not ventilated;

区域性通气-血流匹配%(V/Q Macth%):既有血流灌注也有通气的区域在总区域的百分比。Regional Ventilation-Flow Match % (V/Q Macth %): The percentage of the total area that has both perfusion and ventilation.

经研究验证,上述方法可以有效识别呼吸衰竭患者肺内血流通气分布的异常,在纳入的83例重症患者中,11例诊断为急性肺栓塞,72例患者临床不诊断肺栓塞。应用本发明的相关技术参数死腔通气%>30.37诊断急性肺栓塞,敏感性90.9%,特异性98.6%,诊断效能显著优于传统血清学指标DD二聚体。ROC曲线如图3所示。Studies have verified that the above method can effectively identify the abnormal distribution of pulmonary blood ventilation in patients with respiratory failure. Among the 83 critically ill patients included, 11 were diagnosed with acute pulmonary embolism, and 72 patients were not clinically diagnosed with pulmonary embolism. Using the relevant technical parameters of the present invention to diagnose acute pulmonary embolism with dead space ventilation%>30.37, the sensitivity is 90.9%, the specificity is 98.6%, and the diagnostic efficiency is significantly better than the traditional serological index DD dimer. The ROC curve is shown in Figure 3.

典型病例:Typical cases:

肺栓塞患者A,基本信息:男,59,肺癌术后出现急性呼吸衰竭,经确诊为急性肺栓塞。Pulmonary embolism patient A, basic information: male, 59, acute respiratory failure after lung cancer surgery, diagnosed as acute pulmonary embolism.

肺血管CT造影(图4A)提示肺栓塞,右侧肺动脉可见血栓,肺通气图像(图4B)正常,肺血流灌注图像(图4C)发现右侧肺血流下降,肺通气/血流分布图像(图4D)发现右侧死腔通气增加,和临床诊断一致。Pulmonary CT angiography (Fig. 4A) showed pulmonary embolism, thrombus was seen in the right pulmonary artery, pulmonary ventilation image (Fig. 4B) was normal, pulmonary blood perfusion image (Fig. 4C) showed decreased right pulmonary blood flow, pulmonary ventilation/blood flow distribution The image (Fig. 4D) revealed an increase in right-sided dead space ventilation, consistent with the clinical diagnosis.

血胸患者B,基本信息:男性,40,呼吸衰竭,胸腔肋间动脉破裂出血导致血胸。Hemothorax patient B, basic information: male, 40, respiratory failure, hemothorax caused by rupture of thoracic intercostal artery.

肺CT造影(图5A)提示左下胸腔血胸,肺通气图像(图5B)提示左下通气缺失,肺血流灌注图像(图5C)提示左下通气缺失,肺通气/血流分布图像(图5D)提示左下通气/血流均缺失,和临床诊断一致。Lung CT angiography (Fig. 5A) showed left lower thoracic hemothorax, lung ventilation image (Fig. 5B) showed lack of left lower ventilation, pulmonary blood perfusion image (Fig. 5C) showed left lower ventilation lack, and lung ventilation/blood flow distribution image (Fig. 5D) Prompt left lower ventilation / blood flow are missing, consistent with the clinical diagnosis.

上述实施例为本发明较佳的实施方式,但本发明的实施方式并不受上述实施例的限制,所属领域技术人员应该明白,在本发明的技术方案的基础上,本领域技术人员不需要付出创造性劳动即可做出的各种修改或变形仍在本发明的保护范围。The above-mentioned embodiments are preferred embodiments of the present invention, but the embodiments of the present invention are not limited by the above-mentioned embodiments. Those skilled in the art should understand that on the basis of the technical solutions of the present invention, those skilled in the art do not need to Various modifications or deformations that can be made with creative work are still within the protection scope of the present invention.

Claims (10)

1. A bedside saline contrast-based pulmonary ventilation-perfusion electrical impedance tomography method, the method comprising the steps of:
(1) breath hold tests, requiring a minimum of over 8 seconds;
(2) injecting saline water to perform pulmonary blood perfusion radiography, and continuously acquiring the change of electrical impedance signals of the chest;
(3) performing off-line analysis on the resistance signal data;
preferably, the specific operation of step (1) is as follows: breath hold test, requiring a minimum of more than 8 seconds: when the breathing machine is used for mechanical ventilation, pressing an expiration or inspiration breath-hold key 10 s; the spontaneous breathing patient orders to hold breath for 8 seconds; after the breath holding test is passed, saline angiography EIT examination can be carried out;
preferably, the concentration of the injection saline is 10%, and the injection amount is 10 ml;
more preferably, the specific operation of step (2) is as follows: connecting a test subject with a pulmonary electrical impedance monitoring instrument, preparing 10% NaCl10ml, and confirming that a central venous catheter is established for the patient; after breath holding is started, injecting 10% NaCl10ml from a central venous catheter into the body to carry out pulmonary blood flow perfusion radiography; continuously collecting the change of the electrical impedance signals of the chest at the beginning of 2 minutes before the injection of the saline;
preferably, the step (3) of performing off-line analysis on the resistance signal data includes:
a. constructing a lung blood flow perfusion image;
b. constructing a lung ventilation image;
c. a lung ventilation/blood flow distribution image is constructed.
2. The method of claim 1, wherein the operation of step a comprises: the beginning of the overall resistance curve during breath holding period is named as the starting point of saline entering the body, namely T0, the starting point of saline entering pulmonary vessels is named as T1 after one cardiac cycle, the lowest point of the overall resistance is named as the end point of saline passing pulmonary vessels, namely T2, and the resistance curve of the time period of T0-T1 reflects the saline entering the right heart; pulmonary perfusion images were constructed by slope fitting using the resistance-time variation curves of the various lung regions for the T1-T2 time periods.
3. The method of claim 1, wherein the operation of step b comprises: lung ventilation image construction was performed by changes in lung resistance over at least 5 consecutive respiratory cycles within 1 minute prior to injection.
4. The method of claim 1, wherein the operations of step c comprise: the lung ventilation image and the lung blood flow perfusion image take 20% of the maximum pixel points as a threshold value to construct a lung ventilation/blood flow distribution image.
5. An image monitoring device, characterized in that the device comprises an image processor responsible for generating a lung ventilation image, a lung blood perfusion image from lung ventilation impedance data, lung blood perfusion impedance data; the image processor generating an image from the impedance data according to the method of any one of claims 1-4;
preferably, the device comprises a data receiver which is responsible for receiving the lung ventilation impedance data and the lung blood perfusion impedance data measured by the lung electrical impedance monitoring instrument; the data receiver is connected with the image processor.
6. The apparatus of claim 5, further comprising a controller responsible for controlling display of at least one of a lung ventilation image, a lung blood perfusion image according to a screen mode and a measurement site.
7. The apparatus of claim 6, wherein the controller comprises an image and waveform output control module, an impedance measurement control module, and an information determination and transmission module;
the image and waveform output control module may be configured to control display of at least one of a lung ventilation image, a lung blood flow perfusion impedance image, and a lung ventilation/blood flow distribution image according to a preset screen mode or a measurement site of a subject desired to be monitored;
the impedance measurement control module may be configured to control the electrical impedance monitoring instrument to measure lung ventilation impedance data, lung blood flow perfusion impedance data at the chest of the subject;
the information determination and transmission module may be configured to control features implemented by the data receiver and the image processor and transmit the received lung ventilation impedance data, lung blood flow perfusion impedance data, to the image processor to enable the lung ventilation impedance data, lung blood flow perfusion impedance data to be generated as an image.
8. An image monitoring system, characterized in that the system comprises the image monitoring device of any one of claims 5-7; preferably, the system further comprises a pulmonary electrical impedance monitoring instrument.
9. A method of diagnosing pulmonary embolism, the method comprising constructing a lung ventilation/blood flow distribution image by the method of claim 1, calculating a% dead space ventilation, and diagnosing pulmonary embolism when% dead space ventilation > 30.37%.
10. A pulmonary embolism diagnosis system, characterized in that the system comprises a diagnosis device, which performs the method of claim 9; preferably, the system further comprises an image monitoring device of any one of claims 5-7; more preferably, the system further comprises a pulmonary electrical impedance monitoring instrument.
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