新版左室舒张功能不全指南在ICU的应用现状

Clinical applications of diastolic dysfunction in light of the new guidelines in the intensive care unit

越来越多的证据表明,重症监护病房(ICU)患者左室舒张功能不全(LVDD)与预后恶化有关。2016年美国超声心动图学会和欧洲心血管成像协会推出新版指南,试图简化LVDD的诊断和分级。然而,左室舒张功能在发病前常常是未知的,并且存在一些混杂因素。血管活性药物的使用、正压通气、容量负荷使所提出的监测参数难以解释,尤其是在ICU。在LVDD的诊断和分级标准中,多普勒成像衍生参数e′和E/e′似乎是最可靠的,但也具有局限性。本综述基于新版指南和既往文献进行总结,讨论LVDD不同分级的临床意义和超声心动图表现,描述LVDD对患者预后的影响,并为LVDD患者的管理提供依据。

There is growing evidence both in the perioperative period and in the field of intensive care ( ICU ) on the association between left ventricular diastolic dysfunction ( LVDD) and worse outcomes in patients. In 2016, American Society of Echocardiography and European Association of Cardiovascular Imaging joint recommendations have tried to simplify the diagnosis and the grading of LVDD. However, both an often unknown pre morbid LV diastolic function and the presence of several confounders-i. e., use of vasopressors, positive pressure ventilation, volume loading-make the proposed parameters difficult to interpret, especially in the ICU. Among the proposed parameters for diagnosis and grading of LVDD, the two tissue Doppler imaging derived variables e' and E/e' seem most reliable. However, these are not devoid of limitations. In the present review, we aim at rationalizing the applicability of the recent recommendations to the ICU areas, discussing the clinical meaning and echocardiographic findings of different grades of LVDD, describing the impact of LVDD on patients' outcomes and providing some hints on the management of patients with LVDD.