Zapol W M, Snider M T
N Engl J Med. 1977 Mar 3;296(9):476-80. doi: 10.1056/NEJM197703032960903.
We repeatedly assessed pulmonary and systemic hemodynamics in 30 patients undergoing therapy for severe acute respiratory failure of diverse causes. Pulmonary-artery hypertension and elevated pulmonar vascular resistance were observed in all patients after correction of systemic hypoxemia. Increasing pulmonary blood flow by isoproterenol infusion or decreasing pulmonary blood flow by partial bypass of the right side of the heart minimally altered pulmonary-artery pressure. Although neither elevated pulmonary vascular resistance nor low cardiac index reliably predicted death, survivors had preogressive decreases of pulmonary vascular resistance with time, whereas nonsurvivors tended to maintain or increase pulmonary vascular resistance. Right ventricular stroke-work index was markedly elevated in all patients. The work load imposed upon the right ventricle by elevation of pulmonary vascular resistance may be a factor limiting survival in severe acute respiratory failure.
我们对30例因各种原因接受重症急性呼吸衰竭治疗的患者反复进行了肺和全身血流动力学评估。在纠正全身性低氧血症后，所有患者均出现肺动脉高压和肺血管阻力升高。通过输注异丙肾上腺素增加肺血流量或通过部分右心旁路减少肺血流量，对肺动脉压的影响极小。虽然肺血管阻力升高和心排血量降低均不能可靠地预测死亡，但存活者的肺血管阻力随时间逐渐下降，而非存活者的肺血管阻力往往维持不变或升高。所有患者的右心室每搏功指数均显著升高。肺血管阻力升高给右心室带来的工作负荷可能是重症急性呼吸衰竭患者生存受限的一个因素。
