Ashes Catherine, Roscoe Andrew
aDepartment of Anaesthesia, St Vincent's Hospital, Sydney, New South Wales, Australia bDepartment of Anaesthesia, Papworth Hospital, Cambridge, UK.
Curr Opin Anaesthesiol. 2015 Feb;28(1):38-44. doi: 10.1097/ACO.0000000000000138.
Pulmonary hypertension is associated with increased postoperative morbidity and mortality. Early diagnosis and echocardiographic detection of right ventricular (RV) dysfunction are paramount in perioperative management. The goal of this review is to provide an overview of the recent literature on this topic.
Doppler interrogation of pulmonary artery flow may provide an insight into the severity and mechanism of pulmonary hypertension. Established echocardiographic techniques of RV assessment have multiple limitations. Newer echocardiographic technologies (strain and three-dimensional imaging) are promising, but require further validation in the perioperative setting before they are adopted.
More pulmonary hypertension patients are presenting for noncardiac surgery, creating a challenge for the anesthesiologist. Echocardiographic detection of RV dysfunction can be difficult. Routine use of intraoperative transesophageal echocardiography in major thoracic surgery is not advocated yet, but the development of automated techniques may provide an objective assessment of RV function.
肺动脉高压与术后发病率和死亡率增加相关。早期诊断及通过超声心动图检测右心室（RV）功能障碍在围手术期管理中至关重要。本综述的目的是概述关于该主题的近期文献。
对肺动脉血流进行多普勒检查可深入了解肺动脉高压的严重程度和机制。已确立的右心室评估超声心动图技术存在多种局限性。更新的超声心动图技术（应变和三维成像）前景广阔，但在围手术期应用前还需要进一步验证。
越来越多的肺动脉高压患者接受非心脏手术，这给麻醉医生带来了挑战。通过超声心动图检测右心室功能障碍可能具有难度。目前尚不提倡在主要胸科手术中常规使用术中经食管超声心动图，但自动化技术的发展可能会提供对右心室功能的客观评估。
