心源性休克的机械循环辅助装置治疗进展

Development of Mechanical Circulatory Support in the Treatment of Cardiogenic Shock

机械循环辅助在心源性休克的救治中起着日益重要的作用,可纠正患者的血流动力学紊乱状态,保障再灌注治疗的实施。其中主动脉内球囊反搏最常用也最为成熟;心室辅助装置在逆转休克的血流动力学和代谢参数方面优于标准主动脉内球囊反搏治疗,近年来,经皮左室辅助装置逐渐应用于临床,其创伤小且无需体外循环,是今后的发展方向;目前体外膜氧合器多用在爆发性心肌炎或心脏外科术后支持,其应用于急性心肌梗死并发心源性休克治疗的证据不足,有待于更大规模的临床研究验证。未来循环辅助装置的发展方向是体积小、微创、植入和撤除方便、组织相容性好、辅助效果确切。

Mechanical circulatory support is playing an increasingly important role in the treatment of cardiogenic shock. It can correct a patient＇s hemodynamic disorders, and guarantee the implementation of reperfusion therapy. The intra-aortic balloon pump （IABP） is the most commonly used and mature of the mechanical systems. However, the ventricular assist device is better than the standard IABP treatment for the reversal of hemodynamic shock and metabolic parameters. More recently, the use of the percutaneous left ventricular assist device, a device that inflicts less trauma and has no cardiopulmonary bypass, is increasingly being used in clinical practice. The ECMO is being used in cases of myocarditis or for support after cardiac surgery. The future of mechanical circulatory support is small, minimally invasive, and easy to implant.