| 器官血流动力学新认知:动脉-灌注-静脉 |
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| 引用本文： | 赵华,王小亭,刘大为.器官血流动力学新认知:动脉-灌注-静脉[J].协和医学杂志,2022,13(6):921-928. |
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| 作者姓名： | 赵华 王小亭 刘大为 |
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| 作者单位： | 中国医学科学院北京协和医院重症医学科，北京 100730 |
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| 基金项目： | 北京市科技计划Z201100005520038 |
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| 摘 要： | 重症患者器官血流动力学改变是导致器官功能受损的核心。器官灌注压是保证器官血流的直接动力，受到入器官压力(动脉端的压力)和出器官压力(静脉端压力)的影响。不同器官对血流的调整有独特的灌注压力需求和调节系统，以匹配自身生理需求。动脉端作为器官灌注的供给侧，主要通过灌注压力和调节系统以保证器官的血流。自主调节能力不同的器官对于动脉灌注压的需求并不完全相同，临床应根据相应的自主调节范围寻找合适的动脉端灌注压。器官血流灌注不仅取决于供给侧，还受静脉回流的影响，重要器官的动静脉梯度改变可影响器官血流灌注。此外，由于距离心脏远近不同以及受器官自身特异性的影响，不同器官对于静脉回流障碍的耐受程度不完全一致。临床进行血流动力学干预时，应关注不同压力变化对器官灌注的影响，进而真正实现重症治疗器官化。
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| 关 键 词： | 器官血流动力学 动脉血压 压力自主调节功能 静脉回流 |
| 收稿时间： | 2022-08-25 |
New Cognition of Organ Hemodynamics: Artery-Perfusion-Vein |
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| Affiliation: | Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China |
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| Abstract: | The change of organ hemodynamics in critical patients is key to the impairment of organ function. Organ perfusion pressure is the direct power to ensure organ blood flow, which is affected by inlet organ pressure (arterial pressure) and outlet organ pressure (venous pressure). Different organs have unique perfusion pressure requirements and regulation systems for blood flow adjustment to match their physiological needs. As the supply side of organ perfusion, the blood flow of organs is influenced by mean arterial pressure (MAP)and autoregulation system. Organs with different autoregulatory abilities have different requirements for MAP, so the appropriate MAP should be decided according to the autoregulation range in clinical practice. However, organ blood flow perfusion is not only determined by the supply side, but also affected by venous reflux. Changes in arteriovenous gradient across important organs affect organ blood flow perfusion. Different organs have different tolerance levels for venous reflux disorders because their distance from the heart and the specificity of the organ itself. When conducting hemodynamic intervention, physicians should pay attention to the influence of different pressure changes on organ perfusion. |
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