床旁心脏超声指导下成功救治急性右心衰竭1例报告  

Successful treatment of acute right heart failure under the guidance of point-of-care ultrasound: a case report

作　　者：惠姣洁 赵丹 陈耿靖 许红阳 Hui Jiaojie;Zhao Dan;Chen Gengjing;Xu Hongyang(Department of Critical Care Medicine,Wuxi People's Hospital Affiliated to Nanjing Medical University,Wuxi 214023,Jiangsu,China)

机构地区：[1]南京医科大学附属无锡人民医院重症医学科,江苏无锡214023

出　　处：《中华危重病急救医学》2021年第10期1255-1256,共2页Chinese Critical Care Medicine

基　　金：江苏省卫生计生委青年医学重点人才培养项目,(QNRC2016178)。

摘　　要：近年来,右心功能的评估与管理越来越受到临床的关注,床旁心脏超声为此提供了更多机会。南京医科大学附属无锡人民医院重症医学科成功救治1例三尖瓣置换术后急性右心衰竭患者。该患者床旁心脏超声提示有急性右心衰竭的典型特征,表现为:右心室收缩活动整体减弱,右心室扩大,右心室与左心室内径比值>1,胸骨旁短轴切面可见右心室呈椭圆形,室间隔凸向左心室,且左心室前负荷低,左心室舒张受限。该患者在床旁心脏超声指导下,经强心、调整左右心室前后负荷、改善肾脏血流灌注、呼吸功能支持等治疗后病情趋于好转,床旁心脏超声提示右心室较前缩小、收缩功能好转,左心室舒张功能较前改善,总结该病例的成功救治经验以供参考及借鉴。In recent years,more and more attention has been paid to the evaluation and management of right heart function,for which point-of-care unltrasound provides more opportunities.A patient with acute right heart failure after tricuspid valve replacement was successfully treated in department of critical care medicine of Wuxi People's Hospital Affiliated to Nanjing Medical University.This patient showed typical manifestations of acute right heart failure by point-of-care ultrasound.The overall right ventricular systolic function was weakened,and the right ventricle was enlarged.Ratio of the diameter for right ventricle to left ventricle was greater than 1.In the parasternal short-axis view,the right ventricle was oval,and ventricular septum was convex to the left ventricle.The preload of left ventricular was low and the left ventricular diastolic function was limited.Under the guidance of point-of-care ultrasound,the patient's condition tended to improve after treatments such as strengthening the heart,adjusting the preload and afterload of the left and right ventricles,improving renal blood perfusion,and respiratory support.The right ventricle was smaller than before,the systolic function of right ventricle and diastolic function of left ventricle were improved.The successful treatment experience of this case is summarized for reference.

关 键 词：急性右心衰竭 液体管理 心脏超声 

分 类 号：R541.6[医药卫生—心血管疾病]