Li Yiran, Wang Xiaoqiang, Zong Ruiqing, Wu Feixiang, Lin Hai
Department of Intensive Care Medicine, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Medical University, Shanghai 200438, China.
Department of Anesthesiology, Renji Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200127, China.
Evid Based Complement Alternat Med. 2022 Aug 3;2022:8947780. doi: 10.1155/2022/8947780. eCollection 2022.
To investigate the mechanisms underlying the development of right heart-associated PE.
Right heart-related pulmonary edema (PE) refers to PE resulting from impaired right heart function caused by primary or secondary factors, which is common in critically ill patients. Although the clinical manifestations of different types of right heart-related PE are similar, the pathophysiological changes and treatment methods are significantly different. According to the hemodynamic mechanism, right heart-related PE is primarily classified into two types. One is the increase of right heart flow, including extravascular compression, intravascular compression, cardiac compression, and cardiac decompression. The other type is the abnormal distribution of pulmonary circulation, including obstruction, resistance, pleural decompression, or negative pressure. With the development of hemodynamic monitoring, hemodynamic data not only help us understand the specific pathogenesis of right heart-related PE but also assist us in determining the direction of therapy and enabling individualized treatment. This article presents a review on right heart-associated PE, with a perspective of hemodynamic analysis, and emphasizes the importance of right heart function in the management of circulation. Understanding the mechanism of right heart-associated PE will not only aid in better monitoring right heart function but also help intensivists make a more accurate identification of various types of PE in the clinic.
探讨右心相关性肺栓塞（PE）发生发展的机制。
右心相关性肺水肿（PE）是指由原发性或继发性因素导致右心功能受损所引起的PE，在危重症患者中较为常见。尽管不同类型的右心相关性PE临床表现相似，但其病理生理变化及治疗方法却有显著差异。根据血流动力学机制，右心相关性PE主要分为两种类型。一种是右心血流增加，包括血管外压迫、血管内压迫、心脏压迫和心脏减压。另一种类型是肺循环分布异常，包括阻塞、阻力、胸膜减压或负压。随着血流动力学监测的发展，血流动力学数据不仅有助于我们了解右心相关性PE的具体发病机制，还能协助我们确定治疗方向并实现个体化治疗。本文从血流动力学分析的角度对右心相关性PE进行综述，并强调右心功能在循环管理中的重要性。了解右心相关性PE的机制不仅有助于更好地监测右心功能，还能帮助重症监护医生在临床上更准确地识别各种类型的PE。
