多支血管病变与心源性休克的管理

Management of Multivessel Disease and Cardiogenic Shock.

作者信息

Banning Amerjeet S, Gershlick Anthony H

机构信息

Leicester Cardiovascular Biomedical Research Unit, Department of Cardiovascular Sciences, The National Institute of Health Research (NIHR), University Hospitals of Leicester National Health Service (NHS) Trust, Glenfield Hospital, University of Leicester, Groby Road, Leicester, LE3 9QP, UK.

出版信息

Interv Cardiol Clin. 2016 Oct;5(4):533-540. doi: 10.1016/j.iccl.2016.06.009. Epub 2016 Aug 13.

DOI:10.1016/j.iccl.2016.06.009

PMID:28582001

Abstract

Cardiogenic shock represents a state of low cardiac output and systemic hypoperfusion resulting in insufficient end-organ perfusion and consequent multiorgan failure. The main cause of this complication in the context of acute ST-elevation myocardial infarction is left ventricular dysfunction secondary to poor myocardial perfusion. In over 50% of cardiogenic shock cases, there is evidence of significant coronary stenosis within noninfarct-related arteries. Persistent ischemia in the noninfarct territory may contribute to ongoing hypotension. Currently, ESC and ACC/AHA/SCAI guidelines advocate complete revascularization in the context of multivessel coronary artery disease in the context of cardiogenic shock, although the evidence is weak.

摘要

心源性休克表现为心输出量降低和全身灌注不足的状态，导致终末器官灌注不足，进而引发多器官功能衰竭。急性ST段抬高型心肌梗死并发心源性休克的主要原因是心肌灌注不良继发的左心室功能障碍。在超过50%的心源性休克病例中，有证据表明非梗死相关动脉存在明显的冠状动脉狭窄。非梗死区域的持续性缺血可能导致持续低血压。目前，欧洲心脏病学会（ESC）和美国心脏病学会/美国心脏协会/心血管造影和介入学会（ACC/AHA/SCAI）指南主张在多支冠状动脉疾病并发心源性休克的情况下进行完全血运重建，尽管证据尚不充分。