Duke G J
Intensive Care Department, The Northern Hospital, Epping, Victoria.
Crit Care Resusc. 1999 Dec;1(4):388-99.
To review the cardiovascular effects of spontaneous breathing and mechanical ventilation in healthy and pathological states.
A review of articles published in peer-reviewed journals from 1966 to 1998 and identified through a MEDLINE search on cardiopulmonary interaction.
Respiration has a hydraulic influence upon cardiovascular function. Pulmonary and cardiac pathology alter this interaction. Spontaneous inspiration increases right ventricular (RV) preload and left ventricular (LV) afterload. Mechanical ventilation with positive pressure (MV) reduces LV preload and afterload. The influence of MV upon the cardiovascular system (CVS), particularly in critically ill patients, depends upon the mode of ventilation and the pre-existing cardiac and respiratory status. The influence of these factors is reviewed. Consideration of these parameters will enable the clinician to predict the likely effect of MV and develop strategies to minimise adverse events.
Mechanical ventilation has an adverse effect upon the CVS in healthy subjects and in patients with pulmonary pathology, particularly in the presence of preload-dependent LV dysfunction or afterload-induced RV dysfunction. Mechanical ventilation may benefit cardiac function in patients with respiratory failure and afterload-dependent or exercise-induced LV dysfunction.
回顾健康状态和病理状态下自主呼吸及机械通气对心血管系统的影响。
对1966年至1998年发表在同行评审期刊上的文章进行综述，并通过MEDLINE检索心肺相互作用相关文献来确定。
呼吸对心血管功能有流体力学影响。肺部和心脏疾病会改变这种相互作用。自主吸气会增加右心室（RV）前负荷和左心室（LV）后负荷。正压机械通气（MV）会降低LV前负荷和后负荷。MV对心血管系统（CVS）的影响，尤其是在危重症患者中，取决于通气模式以及先前存在的心脏和呼吸状况。本文对这些因素的影响进行了综述。考虑这些参数将使临床医生能够预测MV可能产生的效果，并制定策略以尽量减少不良事件。
机械通气对健康受试者和肺部疾病患者的CVS有不良影响，尤其是在存在前负荷依赖型LV功能障碍或后负荷诱导型RV功能障碍的情况下。机械通气可能对呼吸衰竭患者以及后负荷依赖型或运动诱导型LV功能障碍患者的心脏功能有益。
