Pöss Janine, Desch Steffen, Thiele Holger
University Hospital Schleswig-Holstein, Campus Lübeck, Department of Internal Medicine/Cardiology/Angiology/Intensive Care Medicine, Lübeck, Germany.
EuroIntervention. 2014 Aug;10 Suppl T:T74-82. doi: 10.4244/EIJV10STA12.
This manuscript outlines the treatment of cardiogenic shock (CS) complicating acute myocardial infarction (AMI), focusing on new therapeutic strategies from the interventional cardiologist's perspective.
CS is a life-threatening complication of AMI occurring in 10% of AMI patients. It can be defined as a state of critical tissue and end-organ hypoperfusion due to reduced cardiac contractility. Early revascularisation is the most important therapeutic measure. Its widespread use has caused a decline in the incidence of CS. However, despite optimal treatment, the mortality rate of CS is still approaches 50%. It is now understood that CS not only involves the heart but the whole circulatory system. In order to increase the survival rates of CS patients, the right decisions have to be taken regarding the optimal revascularisation strategy, treatment with inotropes and vasopressors, mechanical left ventricular support, management of multiorgan dysfunction syndrome, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources.
CS mortality remains unacceptably high. In the light of very limited evidence regarding most treatment modalities, there is a clear need for adequately designed studies in order to answer the numerous unsettled issues.
本手稿概述了并发急性心肌梗死（AMI）的心源性休克（CS）的治疗，重点从介入心脏病专家的角度介绍新的治疗策略。
CS是AMI的一种危及生命的并发症，发生于10%的AMI患者中。它可被定义为由于心脏收缩力降低导致的关键组织和终末器官灌注不足的状态。早期血运重建是最重要的治疗措施。其广泛应用导致了CS发病率的下降。然而，尽管进行了最佳治疗，CS的死亡率仍接近50%。现在人们认识到，CS不仅涉及心脏，还涉及整个循环系统。为了提高CS患者的生存率，必须就最佳血运重建策略、使用正性肌力药物和血管升压药物治疗、机械性左心室支持、多器官功能障碍综合征的管理、额外的重症监护治疗、在不同医院护理水平间进行分诊以及临床资源分配等做出正确决策。
CS的死亡率仍然高得令人难以接受。鉴于关于大多数治疗方式的证据非常有限，显然需要进行设计充分的研究，以回答众多未解决的问题。
