Purkayastha S, Bhangoo P, Athanasiou T, Casula R, Glenville B, Darzi A W, Henry J A
Department of Biosurgery and Surgical Technology, Imperial College, St Mary's Hospital, London, UK.
Emerg Med J. 2006 Apr;23(4):246-50. doi: 10.1136/emj.2005.028605.
Severe poisoning can cause potentially fatal cardiac depression. Cardiopulmonary bypass (CPB) can support the depressed myocardium, but there are no clear indications or guidelines available on its use in severe poisoning. A review was conducted of relevant papers in the available literature (seven single case reports of both deliberate and accidental ingestion of cardiotoxic drugs and two animal studies). Although CPB is rarely used in the management of poisoning, it may have potential benefits for haemodynamic instability not responding to conventional measures. At present there is insufficient evidence concerning the use of CPB as a treatment for severe cardiac impairment due to poisoning (grade C). This review suggests that in patients with severe and potentially prolonged reversible cardiotoxicity there is potential for full survival with CPB, provided that the patient has not already sustained hypoxic cerebral damage due to resistant hypotension prior to its use.
严重中毒可导致潜在致命的心脏抑制。体外循环（CPB）可支持受抑制的心肌，但对于其在严重中毒中的应用，尚无明确的指征或指南。对现有文献中的相关论文进行了综述（7例故意或意外摄入心脏毒性药物的单病例报告以及2项动物研究）。尽管CPB在中毒治疗中很少使用，但对于常规措施无法改善的血流动力学不稳定情况，它可能具有潜在益处。目前，关于CPB作为中毒所致严重心脏损伤的治疗方法，证据不足（C级）。本综述表明，对于严重且可能持续较长时间的可逆性心脏毒性患者，若在使用CPB之前患者尚未因顽固性低血压而发生缺氧性脑损伤，则有可能通过CPB实现完全存活。
