由肺看心:急性呼吸窘迫综合征右心单元的改变

doi:10.3969/j.issn.1674-490X.2024.06.002

摘要/Abstract

摘要： 急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)作为重症之肺部表现,破坏肺脏的有效气体交换面积,通气功能受累。心肺从解剖位置到生理功能密切相关,肺部重症病变必然累及心脏,以右心后向血流改变最为显著。不合理的机械通气、不恰当的容量管理及血管活性药物的应用,给右心前后负荷、右心功能带来灾难性后果。心室间的相互作用,右心功能不全进入自主恶化的恶性循环,出现机体不可逆损伤。重症床旁超声监测不仅有助于ARDS的诊断,而且能够连续与动态监测右心单元的变化,实现右心目标导向的治疗。基于肺保护的循环保护策略是治疗ARDS的基石,是降低重症患者死亡的靶点。

关键词: 急性呼吸窘迫综合征, 急性肺源性心脏病, 血流动力学, 右心

Abstract: Acute respiratory distress syndrome(ARDS),as a pulmonary manifestations of severe diseases, destroys the effective gas exchange area of the lungs and impairs ventilation function. The heart and lungs are closely related from anatomical location to physiological function, and severe pulmonary lesions inevitably involve the heart, with most significant changes in right heart posterior blood flow, unreasonable mechanical ventilation, inappropriate volume management, and application of vasoactive drugs can get catastrophic consequences on right heart anterior posterior load. The interaction between ventricles leads to a vicious cycle of spontaneous deterioration in right heart dysfunction, resulting in irreversible damage to the body. Bedside ultrasound monitoring in critically ill patients not only helps with the diagnosis of ARDS, but also enables continuously and dynamically monitor changes in the right cardiac unit, achieving targeted treatment of the right heart. The circulatory protection strategy based on lung protection is the cornerstone of treating ARDS and a target for reducing mortality in critically ill patients.

Key words: acute respiratory distress syndrome, acute cor pulmonale, hemodynamics, right heart

中图分类号:

瞿海龙,张红强,李建奇,张玲玲. 由肺看心:急性呼吸窘迫综合征右心单元的改变[J]. 医学研究与教育, 2024, 41(6): 9-15.

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