重症急性右心室功能不全的病理生理及诊断  

Pathophysiology and diagnosis of severe acute right ventricular dysfunction

作　　者：庄燕(综述) 陈秋华(审校) ZHUANG Yan;CHENG Qiuhua(Department of Critical Care Medicine,Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Nanjing,Jiangsu 210029,China)

机构地区：[1]南京中医药大学附属医院重症医学科,南京210029

出　　处：《重庆医学》2020年第14期2418-2421,2424,共5页Chongqing medicine

基　　金：国家自然科学基金项目(81703895);江苏省中医院院级课题(Y18011)。

摘　　要：长期以来,对于循环不稳的重症患者临床医师大多关注其左心室功能,对其右心室功能关注不足,但近年来研究发现,右心室功能不全将增加患者总体病死率。右心室独特的解剖和生理功能使右心室更易受各种重症相关疾病的影响,且右心室功能从代偿到失代偿进展迅速。右心室功能不全可影响左心室舒张,导致左心房压力升高及心搏出量降低,可引起右心和左心灌注进一步下降,加重右心功能不全到自主恶化的恶性循环。此外,左心室功能不全亦可通过心室交互作用影响右心室功能。及时发现并积极处理重症患者的右心室功能不全可以更好地救治患者,改善预后。本文回顾、归纳了重症患者急性右心室功能不全的病理生理特征及诊断方法,以期为临床治疗提供指导及借鉴。The role of left ventricle of patients with circulatory shock in intensive care unit has long been considered,and insufficient attention be paied to the right ventricular function.However,recent studies have found thatacute right ventricular dysfunction increases the overall mortality rate.The unique anatomical and physiological function of right ventricle results in right ventricle being more susceptible to various severe diseases,and right ventricular function is progressing rapidly from compensation to decompensation.Right ventricular dysfunction can affect left ventricular diastolic function,leading to increased left atrial pressure and decreased cardiac output,which could aggravate the vicious cycle from right ventricular dysfunction to autonomic deterioration.Additionally,right ventricular dysfunction can lead to left ventricular dysfunction through ventricular interaction.Prompt detection and treatment of right ventricular dysfunction in critically ill patients can improve prognosis.In this paper,the pathophysiology and diagnosis of acute right ventricular dysfunction were reviewed to provide valuable guidance and reference for clinical treatment.

关 键 词：右心室功能不全 急性 病理生理 影像 诊断 

分 类 号：R541[医药卫生—心血管疾病] R459.7[医药卫生—内科学]