急性呼吸窘迫综合征患者右心室功能不全的研究

Study on right ventricular dysfunction in ARDS

目的 研究急性呼吸窘迫综合征 (ARDS)患者右心室功能的变化规律 ,为临床治疗提供理论依据。方法 选择 1996年 5月～ 2 0 0 1年 5月我科加强监护病房 (ICU)收治的ARDS患者 3 0例 ,分为存活组 (A组 ,2 1例 )和死亡组 (B组 ,9例 ) ,对照组为 18例右心室功能正常志愿者。采用REF 1TM 右心功能监测仪和HP监护仪 ,结合超声心动图观察右心室射血分数 (RVEF)、右心室室壁应力 (RVWS)、充盈早期最大流速 (E)与晚期最大流速 (A)之比 (E/A)、充盈早期最大流速减速时间 (Dte)、动脉压 (AP)、平均肺动脉压 (mPAP)、肺血管阻力指数(PVRI)、中心静脉压 (CVP)、右心室舒张末期容积指数 (RVEDVI)、右心室收缩末期容积指数 (RVESVI)、心排指数 (CI)、肺动脉嵌压 (PAWP)、肺毛细血管楔压 (PCWP)、右心室每搏作功指数 (RVSWI)和右心室作功指数(RCWI)的变化。结果 A组患者RVEF、E/A、Dte、RCWI和RVSWI分别为 ( 0 .3 6± 0 .0 8) %、0 .68± 0 .0 9、( 142 .5 6± 16.2 5 )s、( 2 9.81± 6.5 3 ) g/m2 和 ( 1.5 9± 0 .44 ) g·m-1·m-2 ,均较对照组显著下降 (P均 <0 .0 5 ) ;B组患者分别为 ( 0 .2 8± 0 .0 7) %、0 .61± 0 .0 7、( 12 9.3 7± 18.95 )s、( 2 7.2 4± 5 .92 ) g/m2 和 ( 1.3 8± 0 .41) g·m-1·m-2 。

Objective To evaluate the right ventricular function so as to provide theoretic basis for its prevention and treatment in ARDS. Methods 30 patients having ARDS in the ICU from May 1996 to May 2001 were alloted into two groups, the survival group and group death to observe right ventricular ejection fraction (RVEF), mean pulmonary arterial pressure (mPAP), central venous pressure(CVP), pulmonary arterial wedged pressure(PAWP), cardiac output index(CI), right ventricular wall stress (RVWS), maximum early filling flow rate(E) and maximum late flow rate (A), ratio (E/A), deceleration time of E peak(Dte), right cardiac work index (RCWI), right ventricular systolic work index (RVSWI), right ventricular end diastolic volume index (RVEDVI), pulmonary vascular resistance index (PVRI) by electrocardiograms and REF-1 TM ejection fraction/cardiac output monitor. Results The RVEF, E/A, Dte, RCWI, RVSWI in group A were (0.36±0.08)%, 0.68±0.09, (142.56±16.25) s, (29.81±6.53)g/m 2 and (1.59±0.44) g·m -1·m -2 respectively(P<0.05); RVEF, E/A, Dte, RCWI, RVSWI in group B were (0.28±0.07)%, 0.61±0.07, (129.37±18.95) s, (27.24±5.92) g/m 2 and (1.38±0.41) g·m -1·m -2 respectively(P<0.01); RVWS, mPAP, PCWP, PVRI and RVEDVI in group A were (0.34±0.07)mN/cm 2, (3.87±0.40) kPa, (1.47±0.27) kPa, (2.87±0.52) dyn·s·cm -5·m -2 and (118±43) ml/cm 2 respectively(P<0.05); RVWS, mPAP, PCWP, PVRI and RVEDVI in group B were (0.37±0.07) mN/cm 2, (4.80±0.53) kPa, (1.60±0.53) kPa, (3.12±0.63) dyn·s·cm -5·m -2 and (121±39) ml/cm 2 respectively(P<0.01). There were little difference among the two groups with AP, CVP, CI and RVESVI(P>0.05). Conclusion A certain degree of right ventricular dysfunction is present in all patients with ARDS which enhances the critical illness and is the cause of increase of death rate.