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成人心肌炎所致心源性休克的静脉-动脉体外膜肺氧合治疗

Veno-arterial extracorporeal membrane oxygenation for cardiogenic shock due to myocarditis in adult patients.

作者信息

Pozzi Matteo, Banfi Carlo, Grinberg Daniel, Koffel Catherine, Bendjelid Karim, Robin Jacques, Giraud Raphaël, Obadia Jean François

机构信息

Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Claude Bernard University, Lyon, France ;

Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ;

出版信息

J Thorac Dis. 2016 Jul;8(7):E495-502. doi: 10.21037/jtd.2016.06.26.

Abstract

Myocarditis is an inflammatory disease of the heart muscle with established histological, immunological and immunohistochemical diagnostic criteria. Different triggers could be advocated as possible etiologies of myocarditis such as viral and non-viral infections, medications, systemic autoimmune diseases and toxic reactions. The spectrum of clinical presentations of myocarditis is broad and varies from subclinical asymptomatic courses to refractory cardiogenic shock. The prognosis of patients with myocarditis depends mainly on the severity of clinical presentation. In particular, myocarditis patients developing cardiogenic shock refractory to optimal maximal medical treatment may benefit from the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a temporary mechanical circulatory support (MCS). The aim of the present report is to offer a review of the most important articles of the literature showing the results of VA-ECMO in the specific setting of cardiogenic shock due to myocarditis in adult patients.

摘要

心肌炎是一种心肌的炎症性疾病,具有既定的组织学、免疫学和免疫组织化学诊断标准。不同的诱因可被认为是心肌炎可能的病因,如病毒和非病毒感染、药物、全身性自身免疫性疾病及毒性反应。心肌炎的临床表现范围广泛,从亚临床无症状病程到难治性心源性休克不等。心肌炎患者的预后主要取决于临床表现的严重程度。特别是,对于在最佳最大药物治疗下仍难治的心源性休克的心肌炎患者,使用静脉-动脉体外膜肺氧合(VA-ECMO)作为临时机械循环支持(MCS)可能会受益。本报告的目的是对文献中最重要的文章进行综述,这些文章展示了VA-ECMO在成年患者因心肌炎导致的心源性休克这一特定情况下的应用结果。

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