体外心室辅助治疗心源性休克的临床应用现况

Extracorporeal ventricular assist device for acute cardiogenic shock:a review

心源性休克常发于终末期心力衰竭(心衰)急性恶化以及急性心肌梗死患者,是由于各种原因导致的心脏泵功能严重衰退,造成血流动力学急剧不稳、重要器官灌注严重不足的临床综合征,是心衰患者死亡的重要原因。在最佳药物治疗和行冠状动脉(冠脉)血管再通术等非药物治疗措施无效后,这类患者可以使用短期机械循环辅助系统,借此维持血流动力学稳定,保证脏器有效灌注,改善心功能和降低心脏负荷。本文综述了外周机械循环辅助以及外科体外心室辅助治疗心源性休克的临床应用现状。依据本文临床数据分析结果,外科体外心室辅助装置在心源性休克病症治疗的应用中具有生存率高、并发症种类少且发生率低、支持时间长等明显优势,在合适的患者群体中可能具有更好的治疗效果,且有望更加适合于我国国情下的急性心衰治疗和移植前过渡支持。

Cardiogenic shock(CS)often occurs in patients suffering from rapid progression of end-stage heart failure or acute myocardial infarction.It is a state of circulatory failure due to insufficient cardiac output.CS can lead to severe ischemia,hypoxia,metabolic impairment and multi-organ failure and remain the major cause of death in heart failure patients.Mechanical circulatory support may be used for patients,who do not response to optimal medication or revascularization,to stabilize hemodynamics,recover organ perfusion,improve the cardiac function,and unload the failing ventricle.This paper reviews the clinical use of percutaneous mechanical circulatory support devices and surgical extracorporeal ventricular assist devices(Extra-VADs)on cardiogenic shock patients.Extra-VADs have the advantage of high survival rate,less complications,capability for extended support duration.Extra-VADs hold good potential in well-selected patient group and can be promising for acute heart failure treatment and bridge to transplant support in China.