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Modulating the pulmonary circulation: an update

机译:调节肺循环:更新

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Disorders of the pulmonary circulation might develop as a primary disease process of the pulmonary vascular bed or, more often, as the acute or chronic consequence of pulmonary or cardiac pathologies. For the anaesthesiologist and intensivist it is particularly interesting to gain insight into the regulation of the pulmonary circulation since pulmonary hypertension and concomitant right heart failure contribute to high perioperative mortality rates in patients at risk, especially after cardiac surgery. Therefore, modulation of the pulmonary circulation may be a life-saving therapy in patients suffering from acute or chronic pulmonary circulatory disorders. Furthermore, routinely performed intra-operative interventions such as the use of volatile anaesthetics or cardiopulmonary bypass systems may have relevant side effects on the pulmonary circulation. This review focuses on new insights into the modulation of pulmonary circulation during general anaesthesia with volatile anaesthetics and anaesthesiological management during cardiopulmonary surgery. Recent publications in the field of cardiopulmonary bypass surgery, one-lung ventilation and heart and lung transplantation are discussed. Furthermore, the role of conventional and experimental therapeutic strategies to modulate pulmonary circulation in intensive care medicine is reviewed.Despite the performance of a large number of clinical and experimental studies, the pathophysiology of pulmonary circulatory disorders is not completely understood. Therefore, any new therapy has to be carefully evaluated as a therapeutic option. Several formerly experimental therapeutic interventions such as inhaled vasodilators, however, appear to have found their way into clinical practice for selected indications.
机译:肺循环紊乱可能是肺血管床的主要疾病过程,或更常见的是肺或心脏疾病的急性或慢性后果。对于麻醉医师和强化医师而言,深入了解肺循环的调节尤其有趣,因为肺动脉高压和伴随的右心衰竭会导致处于风险中的患者(尤其是心脏手术后)的围手术期死亡率较高。因此,对于患有急性或慢性肺循环疾病的患者,调节肺循环可能是一种挽救生命的疗法。此外,常规执行的术中干预措施,例如使用挥发性麻醉剂或体外循环系统,可能会对肺循环产生不良影响。这篇综述着重介绍了在全身麻醉期间采用挥发性麻醉剂和心肺外科手术进行麻醉管理对肺循环调节的新见解。讨论了体外循环外科手术,单肺通气以及心脏和肺移植领域的最新出版物。此外,综述了常规和实验性治疗策略在重症监护医学中调节肺循环的作用。尽管进行了大量的临床和实验研究,但尚未完全了解肺循环疾病的病理生理学。因此,必须仔细评估任何新疗法作为治疗选择。然而,几种先前的实验性治疗干预措施,例如吸入性血管舒张剂,似乎已针对选定的适应症进入临床实践。

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