Grinstein Jonathan, Gomberg-Maitland Mardi
Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, USA,
Curr Hypertens Rep. 2015 May;17(5):32. doi: 10.1007/s11906-015-0547-z.
Management of acute right ventricular failure, both with and without coexisting pulmonary hypertension, is a common challenge encountered in the intensive care setting. Both right ventricular dysfunction and pulmonary hypertension portend a poor prognosis, regardless of the underlying cause and are associated with significant morbidity and mortality. The right ventricle is embryologically distinct from the left ventricle and has unique morphologic and functional properties. Management of right ventricular failure and pulmonary hypertension in the intensive care setting requires tailored hemodynamic management, pharmacotherapy, and often mechanical circulatory support. Unfortunately, our understanding of the management of right ventricular failure lags behind that of the left ventricle. In this review, we will explore the underlying pathophysiology of the failing right ventricle and pulmonary vasculature in patients with and without pulmonary hypertension and discuss management strategies based on evidence-based studies as well as our current understanding of the underlying physiology.
急性右心室衰竭的管理，无论是否并存肺动脉高压，都是重症监护环境中常见的挑战。右心室功能障碍和肺动脉高压均预示着预后不良，无论其潜在病因如何，且与显著的发病率和死亡率相关。右心室在胚胎学上与左心室不同，具有独特的形态和功能特性。在重症监护环境中管理右心室衰竭和肺动脉高压需要量身定制的血流动力学管理、药物治疗，且常常需要机械循环支持。不幸的是，我们对右心室衰竭管理的理解落后于左心室。在本综述中，我们将探讨有无肺动脉高压患者衰竭的右心室和肺血管系统的潜在病理生理学，并基于循证研究以及我们目前对基础生理学的理解讨论管理策略。
