Ruiz-Bailén Manuel, Rucabado-Aguilar Luis, Expósito-Ruiz Manuela, Morante-Valle Antonia, Castillo-Rivera Ana, Pintor-Mármol Antonio, Rosell-Ortiz Fernando, Mellado-Vergel Francisco José, Machado-Casas Juan, Tejero-Pedregosa Armando, Lara-Torrano Juan
Intensive Care Unit, Emergency and critical Care Service, Medical-Surgical University Hospital, Jaen Hospital Complex, Jaen, Spain.
Med Sci Monit. 2009 Mar;15(3):RA57-66.
This is a review of current knowledge on cardiogenic shock (CS), with particular attention to recommended management. The bibliography for the study was compiled through a search of different databases between 1966-2008. The references cited in the selected articles were also reviewed. The selection criteria included all reports published on CS, from case reports and case series to controlled studies. Languages used were Spanish, French, Italian, Portuguese, German, and English. Cardiogenic shock is the most frequent cause of in-hospital death as a complication of acute coronary syndrome. The incidence is about 7% and, despite therapeutic advances, it continues to have an ominous prognosis, with mortality rates of over 50%. Coronary reperfusion is fundamental in the management of cardiogenic shock, particularly with the use of percutaneous coronary intervention. However, if this is not available, systemic thrombolysis may be performed together with balloon counterpulsation or the use of pressor drugs. Despite the historical importance of the Swan-Ganz catheter, this would appear to have limited use, with echocardiography nonetheless having a fundamental role in the management of CS. Although patients with cardiogenic shock often present a left ventricular ejection fraction of around 30%, survivors often have a good functional classification one year after the event. Neurohormonal and inflammatory mechanisms play a fundamental role in the pathophysiology of CS. These mechanisms are currently the target of studies looking into developing new therapeutic strategies.
这是一篇关于心源性休克（CS）的现有知识综述，特别关注推荐的治疗方法。该研究的参考文献通过检索1966年至2008年期间的不同数据库编制而成。所选文章中引用的参考文献也进行了审查。选择标准包括所有发表的关于心源性休克的报告，从病例报告和病例系列到对照研究。使用的语言有西班牙语、法语、意大利语、葡萄牙语、德语和英语。心源性休克是急性冠状动脉综合征并发症导致住院死亡的最常见原因。发病率约为7%，尽管治疗取得了进展，但它仍然预后不佳，死亡率超过50%。冠状动脉再灌注是心源性休克治疗的基础，特别是使用经皮冠状动脉介入治疗。然而，如果无法进行经皮冠状动脉介入治疗，可以同时进行全身溶栓治疗，并结合球囊反搏或使用升压药物。尽管Swan - Ganz导管具有历史重要性，但它的用途似乎有限，而超声心动图在心源性休克的治疗中仍然起着重要作用。尽管心源性休克患者的左心室射血分数通常约为30%，但幸存者在事件发生一年后通常功能分级良好。神经激素和炎症机制在心源性休克的病理生理学中起着重要作用。这些机制目前是研究开发新治疗策略的目标。
