围心脏手术期被动肺动脉高压:从基础到临床

Passive pulmonary hypertension after cardiac surgery: from bench to bedside

由于左心房压力的升高而导致肺动脉压力升高称为被动肺高压(passive pulmonary hypertension,pPH),多由左心疾病导致,其实质是肺血容量增多,在PH分类中pPH属第二类。最近,我们小组鉴定出另一类pPH,它由血管收缩药物引起,与左心疾病导致的pPH有相似的病理生理表现,二者可以叠加而加重pPH。围心脏手术期,手术创伤导致的心脏功能不全时常使用血管收缩药物,因此临床中pPH的叠加现象可能极为普遍。然而,此类肺高压诊断困难而临床上对此认识不足而常被忽视。为增加对pPH的了解,减轻其临床危害,本文对两类pPH的病理生理及其叠加效应进行综述。

In left heart disease, pulmonary artery pressure would increase due to the elevated left atrial pressure.This type of pulmonary hypertension(PH) is belonged to type Ⅱ as a passive PH(pPH) in its classification. The essential cause of pPH is excessive blood volume. Recently, we have identified another type of pPH, which is induced by vasopressors. Vasopressor-induced pPH shares similar pathophysiological manifestations with left heart disease-induced pPH. pPH would, therefore, be aggressive if vasopressors were applied in patients with left heart disease, which may be common after cardiac surgery, because heart undergoing surgical trauma may require support of vasopressors.Unfortunately, pPH after cardiac surgery is often ignored because of the difficulty in diagnosis. To improve the understanding of pPH and its effect on outcomes, here we highlight the mechanisms of interaction between vasopressorinduced and left heart failure-induced pPH, and provide insights into its therapeutic options.