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急性心功能危机的管理:心源性休克管理策略的全面综述

Managing the acute cardiac functional crisis: a comprehensive review of cardiogenic shock management strategies.

作者信息

Mahajna Ahmad, Bolotin Gil, Lorusso Roberto

机构信息

Department of Cardiac Surgery, Rambam Medical Center, Ombudsman Rambam Health Care Campus, PO Box 9602, Haifa 3109601, Israel.

Cardio-Thoracic Surgery Department, Maastricht University Medical Centre, 6620 ER Maastricht, The Netherlands.

出版信息

Eur Heart J Suppl. 2025 Feb 4;27(Suppl 4):iv4-iv11. doi: 10.1093/eurheartjsupp/suae125. eCollection 2025 Apr.

Abstract

Cardiogenic shock (CS) is a life-threatening condition defined by the heart's inability to adequately pump blood to meet metabolic demands, leading to systemic hypoperfusion and insufficient tissue oxygenation. Despite treatment advancements, CS continues to carry high morbidity and mortality rates, especially when it follows acute myocardial infarction. Various expert groups and scientific societies have proposed recommendations and management pathways, each contributing unique insights yet sometimes overlooking important clinical considerations. This mini-review provides an updated, integrated overview of distinct CS scenarios, including ischaemic, non-ischaemic, and post-cardiotomy categories, and their respective treatment strategies. Additionally, this review explores management approaches that underscore the importance of early detection of inflammatory markers in non-ischaemic CS and targeted therapeutic interventions for each CS subtype. Specifically, the role of pharmacological treatments is examined alongside the relevance and timing of mechanical circulatory support devices. A deeper understanding of the pathophysiology and tailored management pathways for each CS type may enable clinicians to improve interventions and enhance survival and recovery in patients with CS.

摘要

心源性休克(CS)是一种危及生命的病症,其定义为心脏无法充分泵血以满足代谢需求,从而导致全身灌注不足和组织氧合不充分。尽管治疗取得了进展,但CS的发病率和死亡率仍然很高,尤其是在急性心肌梗死后。各个专家小组和科学协会都提出了建议和管理途径,每个都提供了独特的见解,但有时会忽略重要的临床考虑因素。本小型综述提供了不同CS情况的最新综合概述,包括缺血性、非缺血性和心脏手术后类别,以及它们各自的治疗策略。此外,本综述探讨了强调在非缺血性CS中早期检测炎症标志物的重要性以及针对每种CS亚型的靶向治疗干预措施的管理方法。具体而言,研究了药物治疗的作用以及机械循环支持装置的相关性和时机。对每种CS类型的病理生理学和定制管理途径有更深入的了解,可能使临床医生能够改善干预措施,并提高CS患者的生存率和康复率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5fa4/12036514/eb4b49911f21/suae125f1.jpg

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