Jardin F, Dubourg O, Margairaz A, Bourdarias J P
Respiratory Intensive Care Unit, Ambroise Paré Hospital, Boulogne, France.
Chest. 1987 Nov;92(5):789-95. doi: 10.1378/chest.92.5.789.
Right ventricular function was investigated in seven asthmatic patients during an acute attack, using simultaneous bedside right heart catheterization and two-dimensional echocardiography (2DE). Hemodynamic and echocardiographic data were compared during four successive periods of the respiratory cycle: inspiration, early expiration, mid-expiration, and late expiration. During inspiration, 2DE showed a significant increase in right ventricular area at both end-systole and end-diastole. This inspiratory right ventricular enlargement coexisted with a significant reduction in 2DE stroke area and pulmonary artery pulse pressure suggesting an inspiratory reduction in right ventricular stroke output. A transient depression of right ventricular function during deep inspiratory effort in asthma was thus strongly suggested. The negative pressure surrounding the right ventricle at inspiration is advocated as the causative factor enabling reduction in the hydraulic force effecting right ventricular ejection. The highly negative pleural pressure probably holds the right ventricular free wall and restrains its systolic inward motion, as suggested by the finding of a concomitant inspiratory reduction in right ventricular developed pressure and 2DE fractional area contraction.
在七名哮喘急性发作患者中，通过床边同步右心导管检查和二维超声心动图（2DE）对右心室功能进行了研究。在呼吸周期的四个连续阶段：吸气、呼气早期、呼气中期和呼气晚期，对血流动力学和超声心动图数据进行了比较。在吸气期间，2DE显示收缩末期和舒张末期右心室面积均显著增加。这种吸气时右心室扩大与2DE Stroke面积和肺动脉脉压显著降低并存，提示吸气时右心室搏出量减少。因此，强烈提示哮喘患者在深吸气时右心室功能会出现短暂抑制。吸气时右心室周围的负压被认为是导致影响右心室射血的水力减小的因素。高度负压的胸膜可能会拉住右心室游离壁并抑制其收缩时的向内运动，这一发现提示右心室舒张末压和2DE面积分数缩短同时出现吸气性降低。
