“右心为主导”的休克治疗原则——回望我20年前的一项研究

“The Right Heart Priority”in Shock Treatment——My Paper 20 Years Later

休克,虽然早已有明确的诊断标准和治疗规范,但临床上常是将左心室看作心脏整体,以体循环代替整个循环系统。在休克的临床治疗中,右心与肺循环曾经是被遗忘的角落。既往,我们基于自己的工作经验(20年前发表的一篇临床研究论文)提出了“右心为主导”的治疗原则:以右心功能为切入点,根据针对性的监测指标,分别评估左、右心室的功能变化和相互作用关系;以流量指标为龙头,连续与动态、目标导向性地进行定量治疗。用血流动力学指标为循环血流建立完整的临床治疗环路,不仅拓展了休克的理论,而且以血流受损的部位、程度,以及对治疗的反应为依据,形成了新的临床治疗方法和流程。20年来,“右心为主导”的原则不断被证实和普及,积累了大量的临床经验。今日休克的治疗,已立足于临床血流动力学个体化治疗,正在向器官化治疗迈进。

Although the shock has long and routinely been treated,right heart and pulmonary circulation used to be the forgotten corners in clinical management.Twenty years ago,my colleagues and I published the paper Right Ventricular Function of Patients with Septic Shock:Clinical Significance and proposed the strategy of“right heart priority”,in which we took right heart as a starting point,completed whole circulation pathway of blood flow clinically with hemodynamic indicators,and performed treatment based on the hemodynamic changes at real locations,degrees and responses to therapeutic interventions.Over the past 20 years,this strategy has been confirmed by many others and practiced in many hospitals worldwide.The current treatment of shock is a continuous,dynamic,target directed quantitative hemodynamic therapy and is moving from individualized treatment towards organ targeted treatment.