急性呼吸窘迫综合征右心改变的认识进展

尽管治疗方案经历了长足的发展,急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)的病死率仍居高不下。随着研究的深入,学者们逐渐发现ARDS患者不仅出现肺损伤,也会出现循环损伤,导致右心功能不全及急性肺源性心脏病。短暂的低氧血症并非ARDS患者预后的独立危险因素,而循环损伤可直接影响其预后。因此,ARDS治疗的核心逐渐从肺保护转向于右心保护。本文对ARDS右心改变的特点及右心保护的策略进行梳理和总结,同时针对循环保护的环节,提出“抢先保护”的理念,为ARDS的治疗提供新的思路。

Progress in the Understanding of Right Heart Changes in Acute Respiratory Distress Syndrome

Mortality rate of acute respiratory distress syndrome (ARDS) remains high despite the rapid development of treatment in the past fifty years. It is gradually discovered that not only lung injury but also circulatory changes in ARDS patients lead to right-ventricular (RV) failure and acute cor pulmonale (ACP). Short-term hypoxemia is not an independent risk factor. Pulmonary vascular dysfunction has been reported as an independent predictor of death in ARDS patients. As a result, core therapy in ARDS is gradually changed from lung protection to RV protection. In this paper, the characteristics of RV change and the strategies for RV protection in ARDS are reviewed. The existing problems with RV protection scheme are put forward. The concept of preemptive protection is proposed to provide new ideas for the treatment of ARDS in the future.