Wanner Patrick M, Filipovic Miodrag
Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, 4031 Basel, Switzerland.
Division of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland.
J Clin Med. 2020 Feb 5;9(2):432. doi: 10.3390/jcm9020432.
Right ventricular (RV) dysfunction and failure are common and often overlooked causes of perioperative deterioration and adverse outcomes. Due to its unique pathophysiologic underpinnings, RV failure often does not respond to typical therapeutic measures such as volume resuscitation and often worsens when therapy is escalated and mechanical ventilation is begun, with a danger of irreversible cardiovascular collapse and death. The single most important factor in improving outcomes in the context of RV failure is anticipating and recognizing it. Once established, a vicious circle of systemic hypotension, and RV ischemia and dilation is set in motion, rapidly spiraling down into a state of shock culminating in multi-organ failure and ultimately death. Therapy of RV failure must focus on rapidly reestablishing RV coronary perfusion, lowering pulmonary vascular resistance and optimizing volemia. In parallel, underlying reversible causes should be sought and if possible treated. In all stages of diagnostics and therapy, echocardiography plays a central role. In severe cases of RV dysfunction there remains a role for the use of the pulmonary artery catheter. When these mostly simple measures are undertaken in a timely fashion, the spiral of death of RV failure can often be broken or even prevented altogether.
右心室（RV）功能障碍和衰竭是围手术期病情恶化和不良结局的常见且常被忽视的原因。由于其独特的病理生理基础，RV衰竭通常对诸如容量复苏等典型治疗措施无反应，并且在治疗升级和开始机械通气时往往会恶化，存在不可逆心血管崩溃和死亡的风险。改善RV衰竭患者预后的最重要因素是预见并识别它。一旦发生，系统性低血压、RV缺血和扩张的恶性循环就会启动，迅速螺旋式下降至休克状态，最终导致多器官衰竭并最终死亡。RV衰竭的治疗必须集中于迅速重建RV冠状动脉灌注、降低肺血管阻力并优化血容量。同时，应寻找并尽可能治疗潜在的可逆病因。在诊断和治疗的各个阶段，超声心动图都起着核心作用。在严重的RV功能障碍病例中，肺动脉导管仍有应用价值。如果及时采取这些大多较为简单的措施，RV衰竭的死亡螺旋通常可以被打破，甚至完全预防。
