Prondzinsky R, Lemm H, Geppert A, Buerke M, Russ M, Werdan K
Medizinische Klinik I, Carl-von-Basedow-Klinikum Saalekreis gGmbH, Weiße Mauer 52, 06217, Merseburg, Deutschland.
Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale) der Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Deutschland.
Med Klin Intensivmed Notfmed. 2018 May;113(4):267-276. doi: 10.1007/s00063-018-0428-8. Epub 2018 May 2.
Patients with ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI) experience cardiogenic shock in about 6-10% of cases during the hospital treatment. In recent years, the incidence seems to be decreasing due to invasive diagnostics and therapy after myocardial infarction. Early diagnosis is important to initiate immediate revascularization using percutaneous coronary intervention (PCI) with stent implantation as part of cardiogenic shock treatment. Thus, a significant improvement in survival can be achieved. Pharmacological and mechanical support is needed to maintain perfusion of the myocardium and organs. Drug therapy for infarct cardiogenic shock relies on dobutamine for inotropic agent and norepinephrine as a vasopressor. For further inotropic support, data on additional levosimendan treatment are available. The pharmacological therapy is supplemented by mechanical support systems such as Impella (ABIOMED, Danvers, MA, USA) or extracorporeal membrane oxygenation (ECMO). The intra-aortic balloon pump (IABP) is hardly used anymore. The majority of cardiogenic shock survivors have little functional cardiac impairment in the long term. This shows the transient damage component (stunning, inflammation), which underlines the need for a fast and effective cardiovascular supportive therapy.
ST段抬高型心肌梗死（STEMI）和非ST段抬高型心肌梗死（NSTEMI）患者在住院治疗期间约6%-10%的病例会发生心源性休克。近年来，由于心肌梗死后采用侵入性诊断和治疗，其发病率似乎在下降。早期诊断对于作为心源性休克治疗一部分立即使用经皮冠状动脉介入治疗（PCI）并植入支架启动血运重建很重要。因此，可以实现生存率的显著提高。需要药物和机械支持来维持心肌和器官的灌注。梗死性心源性休克的药物治疗依赖多巴酚丁胺作为正性肌力药物，去甲肾上腺素作为血管加压药。对于进一步的正性肌力支持，有关于额外使用左西孟旦治疗的数据。药物治疗由机械支持系统如Impella（美国马萨诸塞州丹弗斯的ABIOMED公司）或体外膜肺氧合（ECMO）补充。主动脉内球囊泵（IABP）几乎不再使用。大多数心源性休克幸存者长期心脏功能损害很小。这显示了短暂性损伤成分（心肌顿抑、炎症），这突出了快速有效的心血管支持治疗的必要性。
