Werdan Karl, Ferrari Markus Wolfgang, Prondzinsky Roland, Ruß Martin
Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Ernst-Gruber-Str. 40, 06120, Halle (Saale), Deutschland.
, Ginsterweg 25, 06120, Halle (Saale), Deutschland.
Herz. 2022 Feb;47(1):85-100. doi: 10.1007/s00059-021-05088-1. Epub 2022 Jan 11.
Cardiogenic shock as a complication of myocardial infarction (5-10%) increases the mortality of uncomplicated myocardial infarction from less than 10% to 40%. This is due to the development of multiple organ dysfunction syndrome triggered by the extensive shock-induced impairment of organ perfusion. Therefore, guideline-based treatment should not only be restricted to reopening of the occluded coronary artery and management of complications of the infarction: important for survival are also guideline-driven optimization of organ perfusion by inotropic and vasoactive substances and, with well-defined indications, by temporary mechanical circulatory support but not by intra-aortic counterpulsation. Equally important, however, are shock-specific intensive care measures to prevent or attenuate organ dysfunction, such as lung protective ventilation in cases where ventilation is obligatory.
心源性休克作为心肌梗死的并发症（发生率为5%-10%），可使无并发症的心肌梗死死亡率从不到10%增至40%。这是由于广泛的休克诱导性器官灌注受损引发了多器官功能障碍综合征。因此，基于指南的治疗不应仅局限于开通闭塞的冠状动脉及处理梗死并发症：对于生存同样重要的是通过使用正性肌力药物和血管活性药物，以及在明确指征下通过临时机械循环支持，而非主动脉内反搏，对器官灌注进行基于指南的优化。然而，同样重要的是采取针对休克的重症监护措施以预防或减轻器官功能障碍，例如在必须进行通气的情况下采用肺保护性通气。
