Rackley C E, Russell R O, Mantle J A, Rogers W J
Cardiovasc Clin. 1981;11(3):15-24.
Cardiogenic shock is a complication of acute myocardial infarction characterized by reduction in systemic blood pressure and clinical evidence of impaired blood flow to the skin, central nervous system, and kidneys. Circulatory changes of cardiogenic shock result from excessive loss of contracting myocardium and impaired mechanical performance of the left ventricle. Hemodynamic measurements of left ventricular filling pressure (recorded as the pulmonary artery end-diastolic pressure) and the cardiac index can identify four different subgroups with hospital mortality ranging from 13 to 100 percent when managed with available pharmacologic agents. Patients in cardiogenic shock with a normal or near normal left ventricular filling pressure may respond to volume expansion by restoration of blood pressure and organ flow. The pharmacologic management of cardiogenic shock can be effectively enhanced by measuring the changes in cardiac index and left ventricular filling pressure before and after various vasopressor, inotropic, and volume expansion agents. A clinical scheme for the management of cardiogenic shock based on hemodynamic measurements delineates optimal medical management as well as recognition of rupture of the ventricular septum or the papillary muscle. Despite the combined medical and surgical advances in cardiogenic shock, hospital mortality remains high due to the extensive loss of contracting myocardium of the left ventricle.
心源性休克是急性心肌梗死的一种并发症，其特征为全身血压降低以及皮肤、中枢神经系统和肾脏血流受损的临床证据。心源性休克的循环变化源于收缩性心肌的过度丧失和左心室机械功能受损。左心室充盈压（记录为肺动脉舒张末期压力）和心脏指数的血流动力学测量可以识别出四个不同的亚组，当使用现有药物治疗时，其医院死亡率在13%至100%之间。左心室充盈压正常或接近正常的心源性休克患者可能通过扩容恢复血压和器官血流。通过测量各种血管升压药、正性肌力药和扩容药使用前后心脏指数和左心室充盈压的变化，可以有效地加强心源性休克的药物治疗。基于血流动力学测量的心源性休克管理临床方案明确了最佳药物治疗以及对室间隔或乳头肌破裂的识别。尽管在心源性休克的药物和手术联合治疗方面取得了进展，但由于左心室收缩性心肌的广泛丧失，医院死亡率仍然很高。
