ICU患者应激性心肌病的研究进展

Research progress of stress cardiomyopathy in patients of ICU

应激性心肌病(SCM)是一种因强烈精神刺激或躯体应激导致短暂性心室扩大及左心室局部收缩功能障碍,并伴有心电图改变为特征的临床综合征。在发病初期SCM患者临床表现及心电图改变与急性冠脉综合征类似,容易误诊。ICU患者由于存在严重躯体疾病,病情危重,躯体常常处于应激状态,同时ICU环境嘈杂,有创性检查操作多,使患者容易产生心理应激,出现烦躁、抑郁、恐惧、焦虑、疼痛及睡眠障碍等,所以ICU患者容易并发SCM,但因ICU患者发生SCM症状不典型,因此早期诊断、优化治疗措施是改善ICU中SCM患者预后的关键。现针对ICU患者SCM的病因、流行病学、病理生理机制、诊断、治疗等方面的研究进展作一综述。

Stress cardiomyopathy(SCM)is a kind of clinical syndrome characterized by transient ventricular enlargement and left ventricular regional systolic dysfunction caused by strong mental stimulation or physical stress,and accompanied by electrocardiogram(ECG)changes.Its clinical symptoms and ECG manifestations are similar to those of acute coronary syndrome in the early stage of onset,which is easy to be misdiagnosed.However,patients in intensive care unit(ICU)are often in critical and severe condition,and they often preceded different degrees by emotional or physical stress.Therefore,patients in ICU are prone to complicated with SCM.Otherwise,the symptoms of SCM patients in ICU are not typical.Early diagnosis and optimal treatment are the key to improve the prognosis of patients in ICU.The etiology,epidemiology,pathophysiological mechanism,diagnosis and management of SCM in ICU are reviewed in this paper.