急性呼吸窘迫综合征右心功能特征及保护的研究进展

Research progress of characteristics and protection of right heart function in patients with acute respiratory distress syndrome

急性呼吸窘迫综合征(ARDS)是重症医学病房(ICU)常见的难治性危重症,病死率居高不下,机械通气是其重要的治疗手段。随着对ARDS发病机制的深入了解,右心及肺循环的重要性引起人们关注。右心室的解剖及生理特征决定了其对后负荷非常敏感,呼吸机参数设置不恰当易加重肺动脉高压,造成急性肺源性心脏病(ACP)。临床上联合应用小潮气量+最佳呼气末正压(PEEP)的肺保护性通气策略,在改善通气/血流比例、提高氧合的同时,能降低呼吸机相关肺损害以及减少对右心功能的影响,避免了自然源性ACP转化为医源性ACP。监测右心功能应该成为危重ARDS患者管理的一个重要方面。本文拟通过对近年关于ARDS患者右心功能变化特征、保护及治疗的研究进行综述,以期提高临床对ARDS右心功能变化及管理的认识。

Acute respiratory distress syndrome(ARDS)is a common refractory critical disease in the ICU,and its mortality rate is still high.Mechanical ventilation is an important treatment for ARDS.Thanks to the in-depth understanding of the pathogenesis of ARDS,scholars have paid attention to the importance of the right heart and pulmonary circulation.The anatomic and physiological characteristics of the right ventricle determine that it is very sensitive to the afterload,and improper parameters of the ventilator may aggravate pulmonary hypertension and cause acute cor pulmonale.The combination of low tidal volume and optimal positive end expiratory pressure can improve the proportion of ventilatory blood flow,improve oxygenation,reduce ventilator-related lung damage and its impact on right heart function,and avoid the transformation of natural acute cor pulmonale into iatrogenic acute cor pulmonale.Monitoring right heart function should be a key point in the management of critical ARDS patients.This paper discusses the characteristics,protection,and treatment of right heart function in ARDS patients in order to improve the clinical understanding and treatment level for this condition.