急性呼吸窘迫综合征的右心保护性通气策略研究进展

Advances in right ventricular protective ventilatory strategy for acute respiratory distress syndrome

急性呼吸窘迫综合征( acute respiratory distress syndrome,ARDS)是一种以快速进展的低氧血症伴非心源性肺水肿为特征的呼吸困难综合征,当前治疗策略主要在于改善氧合和肺的顺应性,把呼吸机相关性肺损伤降到最低.但很多研究发现,ARDS的死因并非肺损伤和低氧血症,而是循环衰竭.肺血管阻力增高引起的急性心功能障碍是循环衰竭的一个重要原因.肺循环功能障碍与ARDS有关,并导致右心室后负荷增加,最终导致右心室衰竭,也称严重的急性肺源性心脏病.不恰当的机械通气也可以导致右心室衰竭,因此应密切监测ARDS患者的右心室功能,本文就右心室保护性通气策略进行初步介绍.

Acute respiratory distress syndrome (ARDS) is a devastating clinical syndrome with the condition of dyspnea, characterized by rapidly progressive hypoxemia with noncardiogenic pulmonary edema.Current therapeutic strategies are based on improving oxygenation and pulmonary compliance while minimizing ventilator-induced lung injury.However, many previous studies had found that the leading risk of ARDS patient′s death is circulatory collapse rather than pulmonary injury or hypoxemia.Additionally, acute cardiac dysfunction caused by increased pulmonary vascular resistance is an important cause of circulatory failure.Besides, with the deepening of the studies, the dysfunction of lung and heart in ARDS patients, also known as severe acute cor pulmonale (ACP), has been shown to be associated with the pathophysiological process of the ARDS and could lead to the increase of right ventricular pressure load, which eventually might result in right ventricular failure.Furthermore, the inappropriate mechanical ventilation could also lead to right ventricular failure, and therefore it′s necessary to closely monitor the function of right ventricular in ARDS patients.To conclude, we will introduce the protective ventilation strategy of right ventricular preliminarily in this review.