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[关于重症超声在病毒性肺炎合并循环功能障碍患者中的应用思考——基于重症超声的新分类与精准治疗]

[Reflections on the Application of Critical Care Ultrasound in Viral Pneumonia Patients with Circulatory Dysfunction-New Classification and Precision Treatment Based on Ciritical Care Ultrasound].

作者信息

Qin Yao, Yin Wan-Hong, Zeng Xue-Ying, Wang Jie, Zhu Yao

机构信息

Emergency Department and Intensive Care Unit, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu 610041, China.

Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu 610041, China.

出版信息

Sichuan Da Xue Xue Bao Yi Xue Ban. 2021 Jul;52(4):555-560. doi: 10.12182/20210360502.

Abstract

Viruses are among the main pathogens of pulmonary infection and tend to cause pandemics of viral pneumonia. Severe viral pneumonia tends to be accompanied by acute respiratory distress syndrome (ARDS) manifestations, displaying highly specific clinical symptoms that are most prominently expressed in the circulatory system. Shock occurred rarely, it occured at a rather late stage in this outbreak of viral pneumonia. However, because of the extensive use of critical care ultrasound, we have a deeper understanding of the characteristics of acute circulatory disorder caused by severe viral pneumonia, prompting us to reflect more thoroughly about circulatory disorders caused by other types of infections. In general, acute circulatory disorder is not uncommon in severe viral pneumonia in this outbreak, and is characterized by vascular damage, volume disorder and cardiac abnormalities of three types, high stress state, acute right ventricular dysfunction and diffuse cardiac inhibition. In the case of poor management in the early stage, these acute circulatory disorders may develop into shock, or directly cause or aggravate other organ dysfunction, for example, acute kidney injury, exacerbating the adverse outcomes. This has allowed us to reflect more thoroughly on the occurrence and development of acute circulatory disorders caused by other infections. Therefore, the classification of acute circulatory disorders based on the modular assessment of critical care ultrasound will help promote better understanding of acute circulatory disorders and further research.

摘要

病毒是肺部感染的主要病原体之一,且往往会引发病毒性肺炎大流行。重症病毒性肺炎往往伴有急性呼吸窘迫综合征(ARDS)表现,呈现出高度特异性的临床症状,在循环系统中表现最为突出。休克很少发生,在此次病毒性肺炎疫情中休克出现在相当晚的阶段。然而,由于重症超声的广泛应用,我们对重症病毒性肺炎所致急性循环障碍的特点有了更深入的认识,促使我们对其他类型感染所致循环障碍进行更深入的思考。总体而言,此次疫情中急性循环障碍在重症病毒性肺炎中并不少见,其特征为血管损伤、容量紊乱和心脏异常三种类型,包括高应激状态、急性右心室功能障碍和弥漫性心脏抑制。在早期管理不善的情况下,这些急性循环障碍可能发展为休克,或直接导致或加重其他器官功能障碍,例如急性肾损伤,从而加剧不良后果。这使我们对其他感染所致急性循环障碍的发生发展进行了更深入的思考。因此,基于重症超声模块化评估的急性循环障碍分类将有助于促进对急性循环障碍的更好理解及进一步研究。

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