脓毒症相关性心肌病:长期预后、管理及指南指导下的药物治疗

Sepsis-Associated Cardiomyopathy: Long-Term Prognosis, Management, and Guideline-Directed Medical Therapy.

作者信息

Hollenberg Steven M

机构信息

Director, Cardiac Intensive Care Emory Heart & Vascular Center, Emory University School of Medicine, Atlanta, GA, USA.

出版信息

Curr Cardiol Rep. 2025 Jan 7;27(1):5. doi: 10.1007/s11886-024-02175-7.

Abstract

PURPOSE OF REVIEW

To explore the definitions of sepsis-induced cardiomyopathy and how that impacts interpretation of the available data and considerations of long-term prognosis and management.

RECENT FINDINGS

The field of sepsis-induced cardiomyopathy has been hampered by lack of consensus about its proper definition, with a great deal of heterogeneity in clinical trial data in both individual studies and meta-analyses and consequent disparity of estimates of incidence, prognosis, and clinical significance. New diagnostic techniques, while potentially shedding light on pathophysiology, have only exacerbated these challenges. There are few persuasive data to suggest that decreased ejection fraction consequent to sepsis-induced cardiomyopathy merits a treatment strategy different from other causes, except that improvement may be more likely inasmuch as the classic description includes reversibility over 7 to 10 days. For persistent cardiac dysfunction after sepsis, whether pre-existing or newly diagnosed, institution and titration of guideline-directed medical therapy for HFrEF seems to be the most logical strategy. Armed with a clear understanding of what parameters of cardiac function are most important, clinicians can develop therapeutic strategies that make sense and calibrate them according to the clinical response.

摘要

综述目的

探讨脓毒症诱导的心肌病的定义,以及该定义如何影响对现有数据的解读以及对长期预后和管理的考量。

最新发现

脓毒症诱导的心肌病领域因缺乏关于其恰当定义的共识而受到阻碍,在个体研究和荟萃分析的临床试验数据中存在大量异质性,导致发病率、预后和临床意义的估计存在差异。新的诊断技术虽然可能有助于揭示病理生理学,但只会加剧这些挑战。几乎没有有说服力的数据表明,脓毒症诱导的心肌病导致的射血分数降低需要一种不同于其他原因的治疗策略,只是由于经典描述包括在7至10天内可逆转,改善的可能性可能更大。对于脓毒症后持续的心脏功能障碍,无论是既往存在的还是新诊断的,启动并滴定针对射血分数降低的心力衰竭(HFrEF)的指南指导药物治疗似乎是最合理的策略。在清楚了解哪些心脏功能参数最重要之后,临床医生可以制定合理的治疗策略,并根据临床反应进行调整。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索