Intensive Cardiac Therapy Clinic, Medical University of Lodz, Poland.
Intensive Cardiac Therapy Clinic, Medical University of Lodz, Poland.
Aust Crit Care. 2019 Jul;32(4):293-298. doi: 10.1016/j.aucc.2018.08.002. Epub 2018 Sep 10.
The development of cardiogenic shock remains the most important factor affecting the prognosis of patients with acute coronary syndrome. Despite significant advances in treatment, achieved in the last two decades, the mortality rate is still very high. The development of knowledge about the pathophysiology of cardiogenic shock, necessitates a thorough and comprehensive assessment of its progress at all stages of medical care.
The aim of the study was to assess the prehospital clinical presentation in patients with acute coronary syndrome complicated by cardiogenic shock.
The population of our study consisted of 40 patients with acute coronary syndrome complicated by cardiogenic shock who were transported to the Intensive Cardiac Therapy Clinic by ambulances directly from place of the event in order to implement primary coronary intervention. The control group was selected among age, gender and infarct location-matched patients with acute coronary syndrome uncomplicated by shock. The clinical presentation in investigated patients was assessed on the basis of the data contained in the medical records of Emergency Medical Services teams.
In univariate logistic regression analysis eight prehospital clinical symptoms proved to be statistically significant predictors of the development of cardiogenic shock: fainting and/or impaired consciousness, pale skin, cold skin, clammy skin, dyspnea, pulmonary congestion, peripheral cyanosis and hyperglycemia >11,1 mmol/l. In the multivariate model significant predictors of cardiogenic shock development were: pale skin and hyperglycemia >11.1 mmol/l. A risk prediction model was constructed. It proved to differentiate patients from study and control group highly significantly (p < 0.001).
Patients with acute coronary syndrome who develop cardiogenic shock, present a different clinical symptoms at the moment of the first medical contact. The proposed 4S Scale can be used for quick assessment of risk in patients with acute coronary syndrome before the development of a fully-blown cardiogenic shock with severe, long-lasting hypotonia.
心源性休克的发展仍然是影响急性冠状动脉综合征患者预后的最重要因素。尽管在过去二十年中取得了显著进展，但死亡率仍然很高。对心源性休克病理生理学的认识不断发展，需要在医疗护理的各个阶段对其进展进行彻底和全面的评估。
本研究旨在评估急性冠状动脉综合征并发心源性休克患者的院前临床表现。
本研究的人群包括 40 名因急性冠状动脉综合征并发心源性休克而由救护车直接从事件发生地送往重症心脏治疗诊所的患者，以便实施直接冠状动脉介入治疗。对照组是在年龄、性别和梗死部位匹配的未并发休克的急性冠状动脉综合征患者中选择的。对研究患者的临床表现进行评估，依据急救医疗服务团队的病历中包含的数据。
在单变量逻辑回归分析中，有 8 种院前临床症状被证明是心源性休克发展的统计学显著预测因素：晕厥和/或意识障碍、苍白皮肤、冰冷皮肤、湿冷皮肤、呼吸困难、肺充血、周围发绀和血糖>11.1mmol/l。在多变量模型中，心源性休克发展的显著预测因素是：苍白皮肤和血糖>11.1mmol/l。构建了一个风险预测模型。它被证明可以非常显著地区分研究组和对照组的患者（p<0.001）。
发生心源性休克的急性冠状动脉综合征患者在首次医疗接触时表现出不同的临床症状。所提出的 4S 量表可用于在完全发展为严重、持久低血压的心源性休克之前，快速评估急性冠状动脉综合征患者的风险。
