Moritz A, Wolner E
Second Surgical Department, University of Vienna, Austria.
Ann Thorac Surg. 1993 Jan;55(1):238-44. doi: 10.1016/0003-4975(93)90530-u.
Cardiogenic shock after acute myocardial infarction develops according to the amount of lost myocardium, function of remote myocardium, and the phenomenon of infarct expansion. Patients treated with mechanical support alone, without additional measures, have a mortality rate of 80%, the same as patients treated medically. Emergency angioplasty and emergency coronary artery bypass grafting can reduce mortality in certain subsets of patients to 40%. Patients with more severe shock and secondary organ dysfunction may be treated with mechanical bridging to transplantation with survival rates varying between 45% and 76%. Percutaneous support systems may be used to resuscitate a patient or to temporize, allowing time to perform diagnostic studies to determine if the patient is suitable for revascularization or heart transplantation. Intravenous enoximone may improve cardiac function as well and thus allow better decision making for further therapy.
急性心肌梗死后的心源性休克根据心肌丧失量、远隔心肌功能及梗死扩展现象而发生。仅接受机械支持治疗而无其他措施的患者死亡率为80%，与接受药物治疗的患者相同。急诊血管成形术和急诊冠状动脉搭桥术可将某些亚组患者的死亡率降至40%。休克更严重且伴有继发器官功能障碍的患者可采用机械桥接至移植治疗，生存率在45%至76%之间。经皮支持系统可用于抢救患者或暂时维持，以便有时间进行诊断性检查，以确定患者是否适合血运重建或心脏移植。静脉注射依诺昔酮也可改善心脏功能，从而为进一步治疗提供更好的决策依据。
