应激性心肌病合并心源性休克病例分析及文献复习

Case study and literature review of stress cardiomyopathy with cardiogenic shock

目的:探讨应激性心肌病(SCM)合并心源性休克的诊断、治疗及预后。方法:对亚洲心脏病医院确诊的SCM合并心源性休克病例做回顾性分析并复习相关文献。结果:2例患者诊断为SCM合并心源性休克。常规抗休克治疗效果欠佳,停用多巴胺/多巴酚丁胺,应用美托洛尔联合IABP后血流动力学改善。结论:对于SCM合并心源性休克,应慎用多巴胺类药物。美托洛尔联合IABP可取得良好的疗效。

Objective: To explore the characteristics of clinical presentation, diagnosis, treatment and outcome of stress cardiomyopathy (SCM) with cardiogenic shock.Methods:Clinical data of SCM with cardiogenic shock were selected and related literatures were reviewed.Results:2 patients were chosen who were diagnosed with SCM combined with cardiogenic shock in Wuhan Asia Heart Hospital. Their clinical presentations were mainly chest pain, cardiac enzymes elevating and cardiogenic shock. Dopamine and dobutamine were ineffective. Hemodynamics was improved after applying metoprolol combined with implantation of intra-aortic balloon pump (IABP) and withdrawing dopamine (or dobutamine). Other medical managements included angiotensin-converting enzyme inhibitors (ACEIs), statins, and anticoagulation. After discharge, the patients were treated with aspirin, metoprolol, and ACEI. During a one-year follow-up, cardiac function completely reversed, and no cardiac events were recorded. Conclusion: In the treatment of SCM with cardiogenic shock,dopamine and dobutamine should be avoided. Metoprolol combined with IABP might achieve good effect. Long-term application with ACEI, statins and metoprolol might be useful to prevent SCM from recurrence.