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中华重症医学电子杂志 ›› 2015, Vol. 01 ›› Issue (01) : 28 -32. doi: 10.3877/cma.j.jssn.2096-1537.2015.01.008

所属专题: 重症医学 文献

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重症患者的心功能障碍:病理生理与治疗
严静1,*,*, 汪月奔1   
  1. 1. 320000 杭州,浙江医院重症医学科
  • 收稿日期:2015-07-08 出版日期:2015-11-28
  • 通信作者: 严静
  • 基金资助:
    国家自然科学基金资助项目(81171784)

Cardiac dysfunction in critical ill patients: pathophysiology and treatment

Jing Yan1, Yueben Wang1   

  1. 1. Intensive Care Unit, Zhejiang Hospital, Hangzhou 320000, China
  • Received:2015-07-08 Published:2015-11-28
  • Corresponding author: Jing Yan
  • About author:
    Corresponding author: Yan Jing, Email: zjicu@vip.163.com
引用本文:

严静, 汪月奔. 重症患者的心功能障碍:病理生理与治疗[J]. 中华重症医学电子杂志, 2015, 01(01): 28-32.

Jing Yan, Yueben Wang. Cardiac dysfunction in critical ill patients: pathophysiology and treatment[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2015, 01(01): 28-32.

重症患者常常发生心功能障碍,其病理生理的改变涉及多种机制,包括血流动力学的变化,神经、内分泌因素的作用,炎症反应,心肌损伤和重构。除了心脏本身病变引起心功能异常外,心外器官如肺、肾、脑、胃肠道等发生功能障碍时亦可引起心功能障碍。对于心功能障碍的重症患者,在改善心功能的同时,需维持血流动力学稳定、加强心外器官的功能支持。

Cardiac dysfunction often happens in critical ill patients with multiple pathophysiological mechanisms, including hemodynamic changes, nerve and endocrine factors, inflammatory reaction, myocardial injury and remodeling. Not only heart disease but also dysfunction of extracardiac organs such as lung, kidney, brain, gastrointestinal can lead to cardiac dysfunction. It is essential to enhance the heart function, maintain the hemodynamic stability and strengthen extracardiac organs function support is also important for critical ill patients with cardiac dysfunction at the same time.

图1 重症患者心功能障碍的识别、评估和治疗
[1]
Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012[J]. Intensive Care Med, 2013, 39(2):165–228.
[2]
Mentz RJ, O'Connor CM. Pathophysiology and clinical evaluation of acute heart failure[J]. Nat Rev Cardiol, 2015, Epub ahead of print.
[3]
Weinbrenner S, Langer T, Scherer M, et al. [The German National Disease Management Guideline "Chronic Heart Failure"][J]. Dtsch Med Wochenschr, 2012, 137(5):219–227.
[4]
Gassanov N, Semmo N, Semmo M, et al. Arginine vasopressin (AVP) and treatment with arginine vasopressin receptor antagonists (vaptans) in congestive heart failure, liver cirrhosis and syndrome of inappropriate antidiuretic hormone secretion (SIADH)[J]. Eur J Clin Pharmacol, 2011, 67(4):333–346.
[5]
Cauwels A, Rogge E, Janssen B, et al. Reactive oxygen species and small-conductance calcium-dependent potassium channels are key mediators of inflammation-induced hypotension and shock[J]. J Mol Med (Berl), 2010, 88(9):921–930.
[6]
耿丽娟, 李素玮, 张永利, 等. 脓毒症心肌损伤发病机制的研究进展[J]. 中华内科杂志, 2015, 54(1):77–80.
[7]
Gupta A, Ghimire G, Hage FG. Guidelines in review: 2013 ACCF/AHA Guideline for the Management of Heart Failure[J]. J Nucl Cardiol, 2014, 21(2):397–399.
[8]
Bronicki RA, Anas NG. Cardiopulmonary interaction[J]. Pediatr Crit Care Med, 2009, 10(3):p. 313–322.
[9]
Broccard AF. Cardiopulmonary interactions and volume status assessment[J]. J Clin Monit Comput, 2012, 26(5):383–391.
[10]
王金祥, 正压通气时的心肺交互作用[J]. 中国呼吸与危重监护杂志, 2006(4):315–317.
[11]
Kovesdy CP, Trivedi BK, Kalantar-Zadeh K, et al. Association of low blood pressure with increased mortality in patients with moderate to severe chronic kidney disease[J]. Nephrol Dial Transplant, 2006, 21(5):1257–1262.
[12]
Kingma JG Jr, Simard D, Rouleau JR. Renocardiac syndromes: physiopathology and treatment stratagems[J]. Can J Kidney Health Dis, 2015, 2:41.
[13]
Mazzeo AT, Micalizzi A, Mascia L, et al. Brain-heart crosstalk: the many faces of stress-related cardiomyopathy syndromes in anaesthesia and intensive care[J]. Br J Anaesth, 2014, 112(5):803–815.
[14]
Pinnamaneni S, Dutta T, Melcer J, et al. Neurogenic stress cardiomyopathy associated with subarachnoid hemorrhage[J]. Future Cardiol, 2015, 11(1):77–87.
[15]
Carr JA. Abdominal compartment syndrome: a decade of progress[J]. J Am Coll Surg, 2013, 216(1):135–146.
[16]
Kirkpatrick AW, Roberts DJ, De Waele J, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome[J]. Intensive Care Med, 2013, 39(7):1190–1206.
[17]
Katsios C, Ye C, Hoad N, et al. Intra-abdominal hypertension in the critically ill: interrater reliability of bladder pressure measurement[J]. J Crit Care, 2013, 28(5):886.e1–6.
[18]
Li Y, Ge S, Peng Y, et al. Inflammation and cardiac dysfunction during sepsis, muscular dystrophy, and myocarditis[J]. Burns & Trauma, 2013, 1(3):109–121.
[19]
Parker MM, Shelhamer JH, Bacharach SL, et al. Profound but reversible myocardial depression in patients with septic shock[J]. Ann Intern Med, 1984, 100(4):483–490.
[20]
Clemente G, Tuttolomondo A, Colomba D, et al. When sepsis affects the heart: A case report and literature review[J]. World J Clin Cases, 2015, 3(8):743–750.
[21]
Antonucci E, Fiaccadori E, Donadello K, et al. Myocardial depression in sepsis: from pathogenesis to clinical manifestations and treatment[J]. J Crit Care, 2014, 29(4):500–511.
[22]
中华医学会重症医学分会. 中国严重脓毒症/脓毒性休克治疗指南(2014)[J]. 中华危重病急救医学, 2015, 13(4):365–367.
[23]
Combes A, Leprince P, Luyt CE, et al. Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock[J]. Crit Care Med, 2008, 36(5):1404–1411.
[24]
Husain-Syed F, McCullough PA, Birk HW, et al. Cardio-Pulmonary-Renal Interactions: A Multidisciplinary Approach[J]. J Am Coll Cardiol, 2015, 65(22):2433–2448.
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