Hasdai D, Topol E J, Califf R M, Berger P B, Holmes D R
Rabin Medical Center, Petah Tikva, Israel.
Lancet. 2000 Aug 26;356(9231):749-56. doi: 10.1016/S0140-6736(00)02640-4.
Cardiogenic shock remains the major cause of death among patients with all types of acute coronary syndromes. Thus, there is a growing interest in the identification of patients who are at risk for developing cardiogenic shock, in the exploration of different therapeutic approaches to preventing its development, and in the improvement of outcome when it occurs. This article reviews the aetiology and pathophysiology of cardiogenic shock, its epidemiology, its treatment (including pharmaceutical agents, counterpulsation, and revascularisation), and its outcome. Algorithms are presented that predict its occurrence in both ST-segment-elevation myocardial infarction and unstable angina or non-ST-elevation myocardial infarction, and that predict its mortality in patients with ST-segment-elevation acute myocardial infarction. Such new areas as metabolic therapy and glycoprotein IIb/IIIa inhibitors are discussed, as are the economic implications of shock.
心源性休克仍然是各类急性冠脉综合征患者死亡的主要原因。因此，对于识别有发生心源性休克风险的患者、探索预防其发生的不同治疗方法以及改善其发生时的预后，人们的兴趣日益浓厚。本文综述了心源性休克的病因、病理生理学、流行病学、治疗（包括药物、反搏和血运重建）及其预后。文中给出了预测ST段抬高型心肌梗死以及不稳定型心绞痛或非ST段抬高型心肌梗死患者发生心源性休克的算法，以及预测ST段抬高型急性心肌梗死患者心源性休克死亡率的算法。文中还讨论了代谢治疗和糖蛋白IIb/IIIa抑制剂等新领域，以及休克的经济影响。
