Madu E C, Brown R, Geraci S A
Department of Medicine, University of Tennessee, Memphis 38163, USA.
Cardiology. 1997 May-Jun;88(3):292-5. doi: 10.1159/000177345.
A paradoxic hypotensive response to resuscitative treatment may be the first clue to dynamic left ventricular outflow tract obstruction (DLVOTO) in critically ill patients. If unrecognized, routine interventions aimed at improving cardiac performance may actually result in hypotension and low cardiac output, thus putting patients at risk for adverse event. It is imperative, therefore, that the pathophysiologic processes involved in DLVOTO be fully understood in order to initiate safe and appropriate therapy in critically ill patients. Our presentation and discussion focus on a hypotensive critically ill patient with unrecognized DLVOTO until further evaluation with transesophageal echocardiogram (TEE). We recommend that early TEE be performed on critically ill patients with unexplained hypotension that is poorly responsive to conventional resuscitative measures.
复苏治疗时出现矛盾性低血压反应可能是危重症患者动态左心室流出道梗阻（DLVOTO）的首个线索。如果未被识别，旨在改善心脏功能的常规干预措施实际上可能导致低血压和低心输出量，从而使患者面临不良事件风险。因此，必须充分了解DLVOTO所涉及的病理生理过程，以便对危重症患者启动安全且适当的治疗。我们的病例介绍和讨论聚焦于一名未被识别出DLVOTO的低血压危重症患者，直至通过经食管超声心动图（TEE）进行进一步评估。我们建议，对于对传统复苏措施反应不佳的不明原因低血压危重症患者，应尽早进行TEE检查。
