在左心衰竭中心肺相互作用
Andrea C Alvarado1, Michael R Pinsky1
1Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
Frontiers in physiology
|August 24, 2023
概括
呼吸的努力通过改变胸内压力 (ITP) 显著影响左心室 (LV) 功能. 非侵入性的连续正气道压力 (CPAP) 可以在急性心脏性肺水腫中快速稳定心血管功能.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 关键护理医学 关键护理医学
背景情况:
- 通风通过胸内压力 (ITP) 变化显著影响左心室 (LV) 功能.
- 自发的灵感努力降低了ITP,增加了静脉回流,但阻碍了LV喷射,可能导致LV衰竭和严重心力衰竭的肺.
- 阳性压力通风增加ITP,减少静脉回流和LV喷射,这可能导致低血压患者的低血压.
研究的目的:
- 阐明通风和通风努力影响左心室 (LV) 和右心室 (RV) 功能的机制.
- 确定使用持续正气道压力 (CPAP) 治疗急性心脏性肺水腫的临床理由.
主要方法:
- 该研究讨论了自发和正压通风对心脏功能的生理影响.
- 它强调了胸内压力 (ITP) 在改变静脉回流和心室喷射的压力梯度中的作用.
- 呼声心脏成像被提及为评估这些影响的床边工具.
主要成果:
- 在自发吸气过程中降低ITP会增加静脉回流和胸内血量,但会阻碍LV喷射.
- 在正压通风期间增加的ITP会减少静脉回流和LV喷射,可能导致低血压.
- 肺体积的变化通过改变肺血管阻力和通过高通胀潜在地阻碍RV填充,从而影响RV功能.
结论:
- 持续的正气压 (CPAP) 可以立即扭转负ITP波动的有害影响,恢复急性心脏性肺的心血管稳定性.
- 了解通风对心脏机制的影响对于管理患有左心室功能障碍和呼吸损害的患者至关重要.
- 积极压力通风策略必须考虑对RV功能,肺血管阻力和肺体积的影响,以优化血液动力稳定性.
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