用于急性脑梗死溶栓治疗监测的电阻抗成像新方法研究

Acute cerebral infarction is a high morbidity, high disability, high mortality rate of cerebrovascular disease, caused by thrombus occlusion of the cerebral arteries. Drug thrombolysis is the most effective treatment, but the treatment process needs to monitor the situation of vascular recanalization and guide follow-up management, meanwhile to timely detect complications such as cerebral hemorrhage and avoid deterioration of the disease or even death. However, there are some shortcomings in the existing technology to evaluate the efficacy and complications. For this reason, we propose a new method for dynamic monitoring of thrombolytic therapy by electrical impedance tomography (EIT) technique according to the advantages of EIT being sensitive to blood flow and tissue function. On the basis of the previous research, this project begins with the development of high-speed and high-speed modular multi-frequency EIT acquisition system, and obtains the fast-changing impedance signal in the brain. By studying the independent component analysis method and the electrical impedance spectroscopy constrained dynamic imaging algorithm, implement information extraction of blood flow and tissue function change and dynamic image reconstruction fusing of multi-frequency information. For thrombolytic monitoring, the research will carry out cerebral hypoxia animal model and clinical thrombolysis control experiment and explore the establishment of an evaluation index model of thrombolytic therapy and an early warning index system of complications based on quantification index and reconstructed impedance spectroscopy change. This research is expected to provide new ideas and techniques for thrombolysis monitoring of acute cerebral infarction, which has important scientific and clinical value.

急性脑梗死是一种高发病率、高致残率、高病死率的脑血管疾病，多由血栓阻塞脑动脉所致。药物溶栓是其最有效的治疗方法，但治疗过程需要监测血管再通情况，指导后续用药，并及时发现脑出血等并发症，避免病情恶化甚至死亡。然而现有技术对疗效评估和并发症预警存在不足，为此我们根据电阻抗成像（EIT）技术对血流和组织功能变化敏感的优势，提出EIT动态监测溶栓治疗的新方法。在前期研究基础上，本项目从研制高精度高速的模块化并行多频EIT采集系统入手，获取颅内快速变化的阻抗信号；通过研究独立成分分析方法和电阻抗频谱约束动态成像算法，实现脑部血流和组织功能变化信息的提取和融合多频信息的动态图像重构；针对溶栓监测的需求，开展脑缺氧动物模型和临床溶栓对照试验，探索建立基于量化指数和重构阻抗谱变化量表征的溶栓疗效分级评估模型和并发症预警指标体系。本研究有望为急性脑梗死溶栓监测提供新思路和新技术，具有重要科学和临床价值。

药物溶栓是临床治疗急性脑梗死的有效方法之一，但治疗过程需要监测血管再通情况，指导后续用药，并及时发现脑出血等并发症，避免病情恶化甚至死亡。针对这一临床实际需求，项目组在前期脑部电阻抗成像（EIT）监护技术研究的基础上，提出EIT动态监测溶栓治疗的新方法，对梗死血管再通血流信号和病灶区脑组织功能变化信号的检测和区分进行了重点攻关。在数据采集系统方面，我们研制了并行高速高精度电阻抗成像测量硬件系统，并基于参考电极法建立了电阻抗成像数据采集系统中多路接触阻抗的实时监测及干扰抑制方法。在数据处理和成像算法方面，我们利用维纳滤波方法对EIT测量数据进行处理，构建了融入颅骨电阻率非均匀分布信息的EIT重构模型，提出了电阻抗频谱约束的多频动态电阻抗成像算法，实现了可区分脑组织成分变化的EIT动态监测方法，并使用基于3D打印技术的具有真实电阻率分布的多层头部物理模型进行了算法性能测试和验证。在此基础上，开展了大鼠急性脑梗死和再灌注、临床急性脑梗死患者溶栓治疗的EIT动态监测实验，结果证实了本项目研制的电阻抗成像系统能够满足临床急性脑梗死溶栓治疗动态监测的基本要求，为进一步的临床应用研究奠定基础。