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反对观点:心脏骤停患者应纳入心源性休克试验。

Con: Cardiac Arrest Patients Should Be Included in Cardiogenic Shock Trials.

作者信息

D'Andria Ursoleo Jacopo, Monaco Fabrizio

机构信息

Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.

Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.

出版信息

J Cardiothorac Vasc Anesth. 2025 Apr 18. doi: 10.1053/j.jvca.2025.04.024.

Abstract

While often being both triggered by acute myocardial infarction, cardiogenic shock (CS) and cardiac arrest (CA) constitute two distinct clinical entities with different underlying pathophysiologic backgrounds. CS is a syndrome characterized by systemic hypoperfusion and end-organ dysfunction due to a primary impairment of the cardiac pump function. CA arises instead from an abrupt loss of cardiac mechanical function-commonly triggered by arrhythmias, structural heart disease, or ischemic events-which leads to the immediate loss of effective circulation. Their diverse sequelae and factors that contribute to patient mortality (i.e., anoxic brain injury for CA and cardiac failure for CS) call for the need to analyze these populations separately in clinical trials.

摘要

虽然心源性休克(CS)和心脏骤停(CA)通常都由急性心肌梗死引发,但它们是两个不同的临床实体,具有不同的潜在病理生理背景。CS是一种综合征,其特征是由于心脏泵功能的原发性损害导致全身灌注不足和终末器官功能障碍。相反,CA是由心脏机械功能突然丧失引起的,通常由心律失常、结构性心脏病或缺血性事件触发,导致有效循环立即丧失。它们不同的后遗症和导致患者死亡的因素(即CA导致的缺氧性脑损伤和CS导致的心力衰竭)要求在临床试验中分别分析这些人群。

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