重症右心功能管理专家共识

·962·中华内科杂志2017年12月第56卷第12期Chin J Intem Med.December2017.Vdl.56.No.12.标准与讨论重症右心功能管理专家共识王小亭刘大为张宏民隆云管向东邱海波于凯江严静赵华汤耀卿丁欣马晓春杜微康焰汤铂艾宇航何怀武陈德昌陈焕柴文昭周翔崔娜王郝芮曦胡振杰李建国许媛杨毅欧阳彬林洪远黎毅敏万献尧杨荣利秦英智晁彦公谢志毅孙仁华何振扬王迪芬黄青青蒋东坡曹相原于荣国王雪陈秀凯吴健峰张丽娜尹万红刘丽霞李素玮陈祖君罗哲重症血流动力学治疗协作组(CHTC Group)Experts consensus on the management of the right heart function in critically ill patientsWangXiaoting,Liu Dawei,Zhang Hongmin,Long Yun,Guan Xiangdong,Qiu Haibo,Yu Kaijang,Yan Jing,ZhaoHua,Tang Yaoqing,Ding Xin,Ma Xiaochun,Du Wei,Kang Yan,Tang Bo,Ai Yuhang,He Huaiwu,ChenDechang,Chen Huan,Chai Wenzhao,Zhou Xiang,Cui Na,Wang Hao,Rui Xi,Hu Zhenjie,Li Jianguo,Xu Yuan,Yang Yi,Ouyan Bin,Lin Hongyuan,Li Yimin,Wan Xianyao,Yang Rongli,Qin Yingzhi,Chao Yangong,Xie Zhiyi,Sun Renhua,He Zhenyang,Wang Difen,Huang Qingqing,Jiang Dongpo,Cao Xiangyuan,Yu Rongguo,WangXue,Chen Xiukai,Wu Jianfeng,Zhang Lina,Yin Wanhong,Liu Lixia,Li Suwei,Chen Zujun,Luo Zhe,CriticalHemodynamic Theraphy Collaboration Group (CHTC Group).Department of Critical Care Medicine,PekingUnion Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing100730,ChinaCorresponding author:Liu Dawei,Email:duliu98@163.com[Summary]To establish the experts consensus on the right heart function management in criticallyill patients.The panel of consensus was composed of 30 experts in critical care medicine who are allmembers of Critical Hemodynamic Therapy Collaboration Group (CHTC Group).Each statement wasassessed based on the GRADE(Grading of Recommendations Assessment,Development,and Evaluation)principle.Then the Delphi method was adopted by 52 experts to reassess all the statements.(1)Right heartfunction is prone to be affected in critically illness,which will result in a auto-exaggerated vicious cycle.2)Right heart function management is a key step of the hemodynamic therapy in critically ill patients.(3)Fluid resuscitation means the process of fluid therapy through rapid adjustment of intravascular volumeaiming to improve tissue perfusion.Reversed fluid resuscitation means reducing volume.(4)The rightventricle afterload should be taken into consideration when using stroke volume variation (SVV)or pulsepressure variation (PPV)to assess fluid responsiveness.(5)Volume overload alone could lead to septaldisplacement and damage the diastolic function of the left ventricle (6)The Starling curve of the rightventricle is not the same as the one applied to the left ventricle,the judgement of the different states for theD01:10.3760Wcma.j.issn.0578-1426.2017.12.019作者名单：100730中国医学科学院北京协和医学院北京协和医院重症医学科（王小亭、刘大为、张宏民、隆云、赵华、丁欣、杜微、汤铂、何怀武、陈焕、柴文昭、周翔崔娜、王郝、芮曦)：中山大学附属第一医院重症医学科（管向东、欧阳彬、吴健峰)：东南大学附属中大医院重症医学科（邱海波、杨毅）：哈尔滨医科大学附属第四医院（于凯江)：浙江医院（严静）：上海交通大学医学院附属瑞金医院重症医学科（汤耀卿、陈德昌）：中国医科大学附属第一医院重症医学科（马晓春）：四川大学华西医院重症医学科（康焰、尹万红）：中南大学湘雅医院重症医学科（艾宇航、张丽娜)：河北医科大学第四医院重症医学科（胡振杰、刘丽霞）：武汉大学中南医院重症医学科（李建国）：北京清华长庚医院重症医学科（许嫒、谢志毅）：解放军，总医院第一附属医院重症医学科（林洪远）：广州医科大学第一附属医院（黎毅敏）：大连医科大学附属第一医院重症医学科（万献尧、李素玮）：大连市中心医院重症医学科（杨荣利)：天津市第三中心医院重症医学科（秦英智）：清华大学第一附属医院重症医学科（晁彦公）；浙江省人民医院重症医学