Loisance D Y, Pouillart F, Benvenuti C, Deleuze P H, Mazzucotelli J P, Le Besnerais P, Mourtada A
Department of Thoracic and Cardiovascular Surgery, Centre National de la Recherche Scientifique, Unité de Recherche Associée 1431, Hospital Henri Mondor, Creteil, France.
Ann Thorac Surg. 1996 Jan;61(1):388-90; discussion 391-2. doi: 10.1016/0003-4975(95)01024-6.
Optimal timing of implantation of a mechanical circulatory support system in the treatment of acute cardiogenic shock is still unsettled. The issue has been addressed in a retrospective analysis of a group of 98 patients in cardiogenic shock refractory to medical therapy who were candidates for cardiac transplantation, admitted from 1987 to 1994.
The treatment included reinforced inotropic support by addition of phosphodiesterase inhibitors to sympathomimetic agents. The patients who did not improve were immediately brought to the operating room for mechanical circulatory support system implantation.
The overall survival in the group of 28 patients selected for mechanical bridge is 50%. No predictive factors of death or multiorgan failure while on the device could be identified, suggesting a lack of contraindications to mechanical circulatory support system implantation.
The high death rate in patients maintained on medical therapy because of initial improvement as they are awaiting transplantation suggests the benefit of a rapid semielective implantation of an intracorporeal device.
在急性心源性休克治疗中，机械循环支持系统植入的最佳时机仍未确定。1987年至1994年收治的一组98例对药物治疗无效的心源性休克患者进行了回顾性分析，这些患者均为心脏移植候选人，探讨了该问题。
治疗包括在拟交感神经药基础上加用磷酸二酯酶抑制剂以增强心肌收缩力支持。病情无改善的患者立即送入手术室植入机械循环支持系统。
入选接受机械桥接治疗的28例患者的总体生存率为50%。未发现使用该装置期间死亡或多器官功能衰竭的预测因素，这表明机械循环支持系统植入没有禁忌证。
因初始病情改善而等待移植期间接受药物治疗的患者死亡率很高，这表明快速半选择性植入体内装置有益。
