Hrymak Carmen, Strumpher Johann, Jacobsohn Eric
Department of Internal Medicine, Section of Critical Care, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Anesthesia and Perioperative Medicine, and Department of Internal Medicine, Section of Critical Care, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Can J Cardiol. 2017 Jan;33(1):61-71. doi: 10.1016/j.cjca.2016.10.030. Epub 2016 Nov 11.
Caring for the critically ill patient with acute right ventricle (RV) failure is a diagnostic and management challenge. A thorough understanding of normal RV anatomy and physiology is essential to manage RV failure. Despite the fact that the RV is essentially a volume chamber that ejects into a low-pressure system, the left ventricle contributes significantly to RV function through maintenance of the transseptal gradient (TSG). Preserving systemic mean arterial pressure maintains the TSG and RV perfusion. Various pathological states cause acute RV failure by decreasing the TSG and RV perfusion and/or increasing pulmonary vascular resistance. Early diagnosis prevents rapid progression of RV failure due to the "double hit phenomenon," which is acute intra-abdominal multiple organ system failure as a result of a reduced blood pressure and elevated central venous pressure. Management includes hemodynamic support and reversal of the precipitating cause through optimizing RV rate and rhythm, determining ideal RV filling pressure, reducing RV afterload through nonpharmacologic and pharmacological means, and selecting the appropriate RV inotrope or mechanical support.
护理患有急性右心室（RV）衰竭的重症患者是一项诊断和管理挑战。全面了解正常右心室的解剖结构和生理功能对于管理右心室衰竭至关重要。尽管右心室本质上是一个将血液射入低压系统的容量腔，但左心室通过维持跨间隔梯度（TSG）对右心室功能有显著贡献。维持体循环平均动脉压可维持TSG和右心室灌注。各种病理状态通过降低TSG和右心室灌注和/或增加肺血管阻力导致急性右心室衰竭。早期诊断可预防由于“双重打击现象”导致的右心室衰竭快速进展，“双重打击现象”是指由于血压降低和中心静脉压升高导致的急性腹腔内多器官系统衰竭。管理措施包括血流动力学支持以及通过优化右心室心率和节律、确定理想的右心室充盈压、通过非药物和药物手段降低右心室后负荷以及选择合适的右心室正性肌力药物或机械支持来逆转诱发原因。
