重症患者左心室舒张功能不全的诊疗进展

Progress in Diagnosis and Treatment of Left Ventricular Diastolic Dysfunction in Critically Ill Patient

重症患者左心室舒张功能不全较常见,主要表现为左心室松弛功能恶化和顺应性下降。二维超声和多普勒超声心动图是其诊断的主要工具。其中,高血压危象相关的急性肺水肿是严重舒张功能不全的最常见表现。且心肌缺血、脓毒症和机械通气撤机失败也与舒张功能不全有关。左心室舒张功能不全的治疗原则主要为减少肺充血和降低左心室充盈压,同时治疗并发的心血管疾病和非心血管疾病。目前,对重症监护病房患者舒张功能不全预测价值的研究较少,未来需进一步进行流行病学研究,以明确其与预后的关系。

Left ventricular diastolic dysfunction is a common finding in critically ill patients,mainly manifested by worsening of left ventricular relaxation function and decreased compliance.Two-dimensional and Doppler echocardiography are the main diagnosis tools.Acute pulmonary edema associated with hypertensive crisis is the most common manifestation of severe diastolic dysfunction.Myocardial ischemia,sepsis and mechanical ventilation failure are also associated with diastolic dysfunction.The therapeutic principles of left ventricular diastolic dysfunction are mainly to reduce pulmonary congestion and reduce left ventricular filling pressure,while treating concurrent cardiovascular diseases and non-cardiovascular diseases.At present,there are few studies on the predictive value of diastolic dysfunction in intensive care unit patients,and further epidemiological studies are needed in the future to clarify its relationship with the prognosis.