Desole S, Kähler C M
Schwerpunkt Pneumologie, Universitätsklinik für Innere Medizin I, Department für Innere Medizin, Medizinische Universität Innsbruck.
Dtsch Med Wochenschr. 2008 Oct;133 Suppl 6:S215-8. doi: 10.1055/s-0028-1091243. Epub 2008 Sep 23.
Right ventricular failure may result from an newly developed disease (e.g. as a consequence of acute respiratory distress syndrome [ARDS] or of severe pulmonary embolism) or of already present pulmonary hypertension (PHT). There is as yet no generally recognized definition of acute or chronic right ventricular failure. The particular clinical picture and the associated hemodynamics determine this condition. Right ventricular failure in the course of PHT represents a great challenge in clinical and intensive care practice. Once the vicious circle of right heart failure is reached an optimal balance has to be found between preload and afterload. In addition to optimizing blood volume, positive inotropic drugs (e.g. dobutamine) are available to maintain systemic blood pressure. Furthermore an increase in right ventricular contractility by inodilators is aimed at. The central goal in the treatment of right heart failure as part of PHT is to lower pulmonary vascular resistance and thus decrease right ventricular afterload. However, it is very difficult to break the vicious circle involved in the acute right heart syndrome, it must be the primary aim of treatment to recognize as early as possible any worsening of PHT and prevent acute right heart failure. Lung transplantation or surgical atrioseptostomy may represent possible ultimate therapeutic options for patients with PHT.
右心室衰竭可能由新出现的疾病（如急性呼吸窘迫综合征[ARDS]或严重肺栓塞所致）或已存在的肺动脉高压（PHT）引起。目前尚无公认的急性或慢性右心室衰竭的定义。其具体临床表现及相关血流动力学情况决定了这一病症。PHT病程中的右心室衰竭是临床和重症监护实践中的一大挑战。一旦进入右心衰竭的恶性循环，就必须在预负荷和后负荷之间找到最佳平衡。除了优化血容量外，还可使用正性肌力药物（如多巴酚丁胺）来维持体循环血压。此外，还旨在通过血管扩张剂增加右心室收缩力。作为PHT一部分的右心衰竭治疗的核心目标是降低肺血管阻力，从而降低右心室后负荷。然而，打破急性右心综合征所涉及的恶性循环非常困难，尽早识别PHT的任何恶化并预防急性右心衰竭必须是治疗的首要目标。肺移植或手术房间隔造口术可能是PHT患者最终的治疗选择。
