Bourdarias J P
Sem Hop. 1979;55(7-8):335-46.
To date, pump failure and its extreme manifestation, cardiogenic shock are the most common cause of death in patients with acute myocardial infarction. Post-mortem studies have shown that primary (myocardial) cardiogenic shock does not occur until some 40 to 50% of the myocardium has been rendered nonfunctional. Not infrequently, cardiogenic shock is mainly the result of a mechanical lesion (mitral regurgitation secondary to papillary muscle dysfonction or rupture, or ventricular septal defect) superimposed upon an ischemic and infarcted ventricle. In both situations medical therapy usually produces only a limited effect. Numerous physiological studies have shown that balloon pumping can reduce the workload and oxygen demands of the heart while increasing coronary blood flow and cardiac output. Most patients with cardiogenic shock can be at least temporarily stabilized, but many patients are balloon-dependent in the sense that when circulatory support is temporarily discontinued, shock or severe heart failure recurs. In these patients, some attempt to correct the underlying anatomic abnormalities appears necessary if they are to survive. Early intra-aortic balloon pumping (IABP) and surgery is much more effective in patients with cardiogenic shock secondary to mechanical complications. Finally, the combination of IABP and surgery has resulted in survival of approximately 50% of patients with cardiogenic shock either primary or secondary.
迄今为止，泵衰竭及其极端表现形式——心源性休克，是急性心肌梗死患者最常见的死亡原因。尸检研究表明，直到约40%至50%的心肌失去功能，才会发生原发性（心肌性）心源性休克。心源性休克常常主要是机械性病变（继发于乳头肌功能障碍或破裂的二尖瓣反流，或室间隔缺损）叠加在缺血性梗死心室上的结果。在这两种情况下，药物治疗通常仅产生有限的效果。大量生理学研究表明，球囊泵血可减少心脏的工作量和氧需求，同时增加冠状动脉血流量和心输出量。大多数心源性休克患者至少可暂时稳定，但许多患者对球囊泵血有依赖，即当循环支持暂时中断时，休克或严重心力衰竭会复发。对于这些患者，如果想要存活，似乎有必要尝试纠正潜在的解剖学异常。早期主动脉内球囊泵血（IABP）和手术对继发于机械性并发症的心源性休克患者更为有效。最后，IABP与手术相结合，使原发性或继发性心源性休克患者的存活率约为50%。
