McLean Barbara
Division of Critical Care, Grady Health System, Atlanta, GA, USA.
Crit Care Nurs Clin North Am. 2015 Dec;27(4):449-67. doi: 10.1016/j.cnc.2015.08.002. Epub 2015 Sep 26.
In critically ill patients with circulatory shock, the role of the left ventricle has long been appreciated and the object of measurement and therapeutic targeting. The right ventricle is often under appreciated and dysfunction may be overlooked. Generally, the right ventricle operates passively to support the ejection of the left ventricular diastolic volume. A loss of right ventricular wall compliance secondary to pulmonary pressures may result in an alteration in the normal pressure-volume relationship, ultimately affecting the stroke volume and cardiac output. Traditional right heart filling indices may increase because of decreasing compliance, further complicating the picture. The pathophysiology of pulmonary vascular dysfunction in acute respiratory distress syndrome combined with the effects of a mean airway pressure strategy may create an acute cor pulmonale.
在患有循环性休克的重症患者中，左心室的作用早已得到认识，并且一直是测量和治疗靶向的对象。右心室常常未得到充分重视，其功能障碍可能被忽视。一般来说，右心室被动工作以支持左心室舒张期容积的射出。继发于肺压力的右心室壁顺应性丧失可能导致正常压力-容积关系改变，最终影响每搏输出量和心输出量。由于顺应性降低，传统的右心充盈指标可能会升高，使情况更加复杂。急性呼吸窘迫综合征中肺血管功能障碍的病理生理学，加上平均气道压力策略的影响，可能会导致急性肺心病。
