Division of Pulmonary and Critical Care medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Room 6728, Los Angeles, CA 90048, USA.
Cedars-Sinai Medical Center, 127 South San Vicente Boulevard, Los Angeles, CA 90048, USA.
Crit Care Clin. 2020 Jul;36(3):505-515. doi: 10.1016/j.ccc.2020.02.006. Epub 2020 May 1.
Acute right ventricular failure remains the leading cause of mortality associated with acute pulmonary embolism (PE). This article reviews the pathophysiology behind acute right ventricular failure and strategies for managing right ventricular failure in acute PE. Immediate clot reduction via systemic thrombolytics, catheter based procedures, or surgery is always advocated for unstable patients. While waiting to mobilize these resources, it often becomes necessary to support the RV with vasoactive medications. Clinicians should carefully assess volume status and use caution with volume resuscitation. Right ventricular assist devices may have an expanding role in the future.
急性右心衰竭仍然是急性肺栓塞（PE）相关死亡的主要原因。本文综述了急性右心衰竭背后的病理生理学以及急性 PE 中右心衰竭的治疗策略。对于不稳定患者，始终提倡通过全身溶栓、导管介入或手术立即进行血栓清除。在等待这些资源动员的同时，通常需要使用血管活性药物来支持 RV。临床医生应仔细评估容量状态，并谨慎使用容量复苏。未来，右心室辅助设备可能会发挥更大的作用。
