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Phân tích tổng thể tạm thời về chức năng tâm thất phải và hemodynamics phổi ở bệnh nhân COVID-19 ARDS được thở máy
Tóm tắt
Tổn thương tim thường được báo cáo ở bệnh nhân COVID-19, trong đó tâm thất phải (RV) thường bị ảnh hưởng nhất. Chúng tôi đã đánh giá hệ thống chức năng tim và sự thay đổi theo chiều dọc ở bệnh nhân COVID-19 nặng mắc hội chứng suy hô hấp cấp (ARDS) nhập viện tại đơn vị chăm sóc tích cực (ICU) và đánh giá tác động đến sống sót. Chúng tôi đã thực hiện phân tích siêu âm tim toàn diện trong thời gian thực với các bệnh nhân ARDS COVID-19 thở máy, sử dụng siêu âm hai chiều và ba chiều. Chúng tôi xác định rối loạn chức năng tâm thất trái (LV) khi phân suất tống máu (EF) < 40% hoặc biến dạng theo chiều dọc (LS) > -18% và rối loạn chức năng RV nếu có hai chỉ số trong số phân suất thay đổi diện tích (FAC) < 35%, độ biến thiên bề mặt đỉnh van ba lá (TAPSE) < 1.6 cm, RV EF < 44%, RV–LS > -20%. Tải sau RV được đánh giá từ áp lực động mạch phổi tâm thu (PASP), PASP/Velocity Time Integral trong ống thoát tâm thất phải (VTIRVOT) và thời gian gia tốc phổi (PAcT). TAPSE/PASP đánh giá sự kết hợp giữa tâm thất phải và động mạch (VACR). Trong số 176 bệnh nhân được đưa vào nghiên cứu, rối loạn chức năng RV là phổ biến (69%) (RV–EF 41.1 ± 1.3%; RV–FAC 36.6 ± 0.9%, TAPSE 20.4 ± 0.4mm, RV–LS: -14.4 ± 0.4%), thường đi kèm với giãn RV (RVEDA/LVEDA 0.82 ± 0.02). Tải sau RV tăng lên ở hầu hết các bệnh nhân (PASP 33 ± 1.1 mmHg, PAcT 65.3 ± 1.5 ms, PASP/VTIRVOT, 2.29 ± 0.1 mmHg/cm). VACR là 0.8 ± 0.06 mm/mmHg. LV–EF < 40% có mặt trong 21/176 (11.9%); LV–EF trung bình 57.8 ± 1.1%. LV–LS (-13.3 ± 0.3%) cho thấy rối loạn LV không rõ ràng ở 87.5%. Tràn dịch màng tim nhẹ có mặt ở 70 (38%) bệnh nhân, thường xuyên hơn ở những người không sống sót (p < 0.05). Những bệnh nhân sống sót có sự cải thiện đáng kể trong sinh lý hô hấp vào ngày thứ 10 ICU (PaO2/FiO2, 231.2 ± 11.9 so với 120.2 ± 6.7 mmHg; PaCO2, 43.1 ± 1.2 so với 53.9 ± 1.5 mmHg; độ tuân thủ hệ hô hấp - CRS, 42.6 ± 2.2 so với 27.8 ± 0.9 ml/cmH2O, tất cả đều p < 0.0001). Hơn nữa, những bệnh nhân sống sót có sự giảm đáng kể tải sau RV (PASP: 36.1 ± 2.4 đến 20.1 ± 3 mmHg, p < 0.0001, PASP/VTIRVOT: 2.5 ± 1.4 đến 1.1 ± 0.7, p < 0.0001 PAcT: 61 ± 2.5 đến 84.7 ± 2.4 ms, p < 0.0001), liên quan đến sự cải thiện chức năng tống máu RV (RVEF: 36.5 ± 2.9% đến 46.6 ± 2.1%, p = 0.001 và RV–LS: -13.6 ± 0.7% đến -16.7 ± 0.8%, p = 0.001). Bên cạnh đó, giãn RV đã giảm ở những bệnh nhân sống sót (RVEDA/LVEDA: 0.8 ± 0.05 đến 0.6 ± 0.03, p = 0.001). CRS vào ngày thứ 10 có tương quan với tải sau RV (PASP/VTIRVOT, r: 0.535, p < 0.0001) và chức năng tống máu (RV–LS, 0.345, p = 0.001). LV–LS trong ngày thứ 10 ICU, trong khi ΔRV–LS và ΔPASP/RVOTVTI có liên quan đến sống sót. Sự cải thiện chức năng RV ở bệnh nhân COVID-19, tải sau RV và sự kết hợp RV–PA vào ngày thứ 10 có liên quan đến chức năng hô hấp và sự sống sót.
Từ khóa
#COVID-19 #tâm thất phải #tổn thương tim #hồi sức hô hấp #chức năng timTài liệu tham khảo
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