Gaines W E
Cardiovasc Clin. 1987;17(2):231-8.
When right ventricular failure prohibits separation from cardiopulmonary bypass, standard methods of increasing pulmonary blood flow should be employed, including correction of hypoxia and acidosis, volume loading, and inotropic support of the right ventricle. Infusion of pulmonary vasodilators--particularly low-dose nitroprusside--should be used if the pulmonary vascular resistance is elevated. If pulmonary blood flow remains unsatisfactory, systemic intra-aortic balloon counterpulsation should be employed. In refractory cases, right-atrial-to-pulmonary-artery bypass using the Bio-Medicus centrifugal pump is the recommended therapy for those centers that do not have the Pierce-Donachy pneumatic ventricular assist-pump available. For refractory right ventricular failure following the surgical repair of congenital cardiac defects in which the placement of right atrial and pulmonary artery cannulae is not technically feasible, use of high-frequency high-volume ventilation appears to be quite promising. Utilization of pulmonary artery counterpulsation or the creation of an atrial septal defect may also be lifesaving, but is not recommended as the therapy of choice.
当右心室衰竭导致无法脱离体外循环时，应采用增加肺血流量的标准方法，包括纠正缺氧和酸中毒、容量负荷以及右心室的正性肌力支持。如果肺血管阻力升高，应使用肺血管扩张剂进行输注，尤其是低剂量硝普钠。如果肺血流量仍不理想，应采用全身主动脉内球囊反搏。在难治性病例中，对于没有皮尔斯 - 多纳希气动心室辅助泵的中心，使用Bio-Medicus离心泵进行右心房至肺动脉旁路是推荐的治疗方法。对于先天性心脏缺陷手术修复后难治性右心室衰竭，若技术上无法放置右心房和肺动脉插管，高频大容量通气似乎很有前景。利用肺动脉反搏或制造房间隔缺损也可能挽救生命，但不建议作为首选治疗方法。
