Cardiology and Critical Care Medicine, Cooper University Hospital, Camden, New Jersey 08103, USA.
Semin Respir Crit Care Med. 2011 Oct;32(5):598-606. doi: 10.1055/s-0031-1287869. Epub 2011 Oct 11.
Cardiovascular system failure is commonly faced by the intensivist. Heart failure can occur due to a host of predisposing cardiac disorders or as secondary effects of systemic illness. When the heart is unable to provide an adequate cardiac output to maintain adequate tissue perfusion, cardiogenic shock ensues. Without prompt diagnosis and appropriate management, these patients have significant morbidity and mortality, with in-hospital mortality approaching 60% for all age groups. Accurate and rapid identification of cardiogenic shock as a medical emergency, with expeditious implementation of appropriate therapy, can lead to improved clinical outcomes. In this review, we discuss optimal strategies for diagnosis and monitoring of cardiogenic shock. We discuss the diverse therapeutic strategies employed for cardiogenic shock, including pharmacological (e.g., vasoactive agents, fibrinolytic agents), mechanical (e.g., intraaortic balloon pumps, left ventricular assist devices, percutaneous coronary intervention [PCI]), and surgical approaches such as coronary artery bypass graft (CABG), valvular repair or replacement (e.g., for acute mitral regurgitation, ventricular septal rupture, or free wall rupture).
心血管系统衰竭是重症监护医生经常面临的问题。心力衰竭可能由于多种潜在的心脏疾病引起，也可能是全身性疾病的继发效应。当心脏无法提供足够的心输出量以维持足够的组织灌注时，就会发生心源性休克。如果没有及时诊断和适当的治疗，这些患者的发病率和死亡率都很高，所有年龄段的住院死亡率接近 60%。准确快速地识别心源性休克作为一种医疗紧急情况，并迅速实施适当的治疗，可以改善临床结局。在这篇综述中，我们讨论了心源性休克的诊断和监测的最佳策略。我们讨论了用于心源性休克的各种治疗策略，包括药理学（例如，血管活性药物、纤维蛋白溶解剂）、机械学（例如，主动脉内球囊泵、左心室辅助装置、经皮冠状动脉介入治疗[PCI]）以及手术方法，如冠状动脉旁路移植术（CABG）、瓣膜修复或置换（例如，用于急性二尖瓣反流、室间隔破裂或游离壁破裂）。
