Licker Marc, Hagerman Andres, Jeleff Alexandre, Schorer Raoul, Ellenberger Christoph
Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospital of Geneva, CH-1205 GENEVA, Switzerland.
Faculty of Medicine, University of Geneva, Switzerland.
Saudi J Anaesth. 2021 Jul-Sep;15(3):250-263. doi: 10.4103/sja.sja_1216_20. Epub 2021 Jun 19.
More than 70 years after its original report, the hypoxic pulmonary vasoconstriction (HPV) response continues to spark scientific interest on its mechanisms and clinical implications, particularly for anesthesiologists involved in thoracic surgery. Selective airway intubation and one-lung ventilation (OLV) facilitates the surgical intervention on a collapsed lung while the HPV redirects blood flow from the "upper" non-ventilated hypoxic lung to the "dependent" ventilated lung. Therefore, by limiting intrapulmonary shunting and optimizing ventilation-to-perfusion (V/Q) ratio, the fall in arterial oxygen pressure (PaO) is attenuated during OLV. The HPV involves a biphasic response mobilizing calcium within pulmonary vascular smooth muscles, which is activated within seconds after exposure to low alveolar oxygen pressure and that gradually disappears upon re-oxygenation. Many factors including acid-base balance, the degree of lung expansion, circulatory volemia as well as lung diseases and patient age affect HPV. Anesthetic agents, analgesics and cardiovascular medications may also interfer with HPV during the perioperative period. Since HPV represents the homeostatic mechanism for regional ventilation-to-perfusion matching and in turn, for optimal pulmonary oxygen uptake, a clear understanding of HPV is clinically relevant for all anesthesiologists.
在其最初报道70多年后，缺氧性肺血管收缩（HPV）反应仍继续引发人们对其机制及临床意义的科学兴趣，尤其对于参与胸外科手术的麻醉医生而言。选择性气道插管和单肺通气（OLV）有助于对萎陷肺进行手术干预，而HPV会将血流从“上侧”未通气的缺氧肺重新导向“下侧”通气肺。因此，通过限制肺内分流并优化通气/血流（V/Q）比值，在OLV期间动脉血氧分压（PaO）的下降会减弱。HPV涉及肺血管平滑肌内动员钙的双相反应，该反应在暴露于低肺泡氧分压后数秒内被激活，并在再给氧时逐渐消失。包括酸碱平衡、肺扩张程度、循环血容量以及肺部疾病和患者年龄在内的许多因素都会影响HPV。麻醉药、镇痛药和心血管药物在围手术期也可能干扰HPV。由于HPV代表区域通气/血流匹配进而实现最佳肺氧摄取的稳态机制，因此，对所有麻醉医生来说，清楚了解HPV具有临床相关性。
