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中华重症医学电子杂志 ›› 2020, Vol. 06 ›› Issue (03) : 322 -328. doi: 10.3877/cma.j.issn.2096-1537.2020.03.016

所属专题: 文献

综述

急性呼吸窘迫综合征右心功能特征及保护的研究进展
王子丹1, 李秀2, 李雪3, 李俊芳4, 李荣4, 刘建芳5, 单亮1,()   
  1. 1. 266071 青岛大学附属医院重症医学科
    2. 266071 青岛大学附属医院门诊部
    3. 230061 安徽医科大学第三附属医院暨合肥市第一人民医院神经内科
    4. 266071 青岛大学附属医院心脏超声科
    5. 276800 日照市人民医院药剂科
  • 收稿日期:2019-09-06 出版日期:2020-08-28
  • 通信作者: 单亮

Research progress of characteristics and protection of right heart function in patients with acute respiratory distress syndrome

Zidan Wang1, Xiu Li2, Xue Li3, Junfang Li4, Rong Li4, Jianfang Liu5, Liang Shan1,()   

  1. 1. Intensive Care Unit, the Affiliated Hospital of Qingdao University, Qingdao 266071, China
    2. Department of Outpatient, the Affiliated Hospital of Qingdao University, Qingdao 266071, China
    3. Department of Neurology, the Third Affiliated Hospital of Anhui Medical University & the First People's Hospital of Hefei, Hefei 230061, China
    4. Department of Echocardiography, the Affiliated Hospital of Qingdao University, Qingdao 266071, China
    5. Department of Pharmacy, the People's Hospital of Rizhao, Rizhao 276800, China
  • Received:2019-09-06 Published:2020-08-28
  • Corresponding author: Liang Shan
  • About author:
    Corresponding author: Shan Liang, Email:
引用本文:

王子丹, 李秀, 李雪, 李俊芳, 李荣, 刘建芳, 单亮. 急性呼吸窘迫综合征右心功能特征及保护的研究进展[J/OL]. 中华重症医学电子杂志, 2020, 06(03): 322-328.

Zidan Wang, Xiu Li, Xue Li, Junfang Li, Rong Li, Jianfang Liu, Liang Shan. Research progress of characteristics and protection of right heart function in patients with acute respiratory distress syndrome[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2020, 06(03): 322-328.

急性呼吸窘迫综合征(ARDS)是重症医学病房(ICU)常见的难治性危重症,病死率居高不下,机械通气是其重要的治疗手段。随着对ARDS发病机制的深入了解,右心及肺循环的重要性引起人们关注。右心室的解剖及生理特征决定了其对后负荷非常敏感,呼吸机参数设置不恰当易加重肺动脉高压,造成急性肺源性心脏病(ACP)。临床上联合应用小潮气量+最佳呼气末正压(PEEP)的肺保护性通气策略,在改善通气/血流比例、提高氧合的同时,能降低呼吸机相关肺损害以及减少对右心功能的影响,避免了自然源性ACP转化为医源性ACP。监测右心功能应该成为危重ARDS患者管理的一个重要方面。本文拟通过对近年关于ARDS患者右心功能变化特征、保护及治疗的研究进行综述,以期提高临床对ARDS右心功能变化及管理的认识。

Acute respiratory distress syndrome (ARDS) is a common refractory critical disease in the ICU, and its mortality rate is still high. Mechanical ventilation is an important treatment for ARDS. Thanks to the in-depth understanding of the pathogenesis of ARDS, scholars have paid attention to the importance of the right heart and pulmonary circulation. The anatomic and physiological characteristics of the right ventricle determine that it is very sensitive to the afterload, and improper parameters of the ventilator may aggravate pulmonary hypertension and cause acute cor pulmonale. The combination of low tidal volume and optimal positive end expiratory pressure can improve the proportion of ventilatory blood flow, improve oxygenation, reduce ventilator-related lung damage and its impact on right heart function, and avoid the transformation of natural acute cor pulmonale into iatrogenic acute cor pulmonale. Monitoring right heart function should be a key point in the management of critical ARDS patients. This paper discusses the characteristics, protection, and treatment of right heart function in ARDS patients in order to improve the clinical understanding and treatment level for this condition.

图1 心脏各房室的解剖关系[6] 图a为心脏前后位图,可见左、右心室及其流出道;图b为心脏右前位,可见右心室形似三角形;图c为心脏俯视图,可见右心室包绕着左心室;图d为心脏膈面图,可显示心房及心室位置关系;图e为心脏四腔、二尖瓣及三尖瓣位置关系
图2 重症呼吸窘迫综合征机械通气合并急性肺源性心脏病[13] 图a、b为经胸、经食道超声心动图,四腔心切面显示重度扩张的右心室;图c、d为经胸、经食管超声心动图,左心室短轴切面示室间隔收缩末矛盾运动(D字征)
图3 肺复张与肺血管阻力关系示意图[19] 图a为右心功能在评估肺复张与肺膨胀平衡关系;图b为肺血管阻力的价值
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