危重症患者应激性心肌病的研究进展

Current status of research in stress cardiomyopathy of critical patients

应激性心肌病(stress cardiomyopathy,SCM)是一种以可逆性室壁运动异常为特点的原发性心肌病,临床表现与急性心肌梗死相似,常表现为心前区的疼痛,呼吸困难,心电图上有ST段,T波,QT间期的改变,同时伴心肌酶谱的升高。典型的左室造影表现为节段性收缩功能障碍(心尖运动减弱或运动不能),冠状动脉造影一般正常。常见于绝经期后女性,发病之前多存在精神或躯体应激因素,真正的发病机制目前仍不完全明确,主要发病机制可能为儿茶酚胺介导的心肌损伤。治疗主要为支持治疗,同时针对并发症,本病预后良好且复发少见。危重症患者多存在严重疾病,精神及躯体均处于不同程度的应激状态,而这样的应激状态可以导致应激性心肌病。因此,现重点从危重症患者的角度来论述应激性心肌病的研究进展。

Stress cardiomyopathy is characterized by reversible left ventricular dysfunction. It simulates an acute coronary syndrome( ACS),presenting with precordial pain or dyspnoea, changes of the ST segment, T wave, or QT interval on electrocardiogram, and raises cardiac enzymes. Typical findings are disturbances of segmental contractility( apical hypokinesia or akinesia),with normal epicardial coronary arteries. It is more common in postmenopausal women. There is usually a trigger in the form of physical or psychological stress. The aetiology and pathogenesis of this disorder are unknown. One theory is the direct effects of catecholamines on the myocardium( cellular damage). The maim treatment is supporting therapy and aim at complications. The prognosis is generally favourable,and recurrence is very rare. The critically ill patients have severe diseases,such as sepsis. The situation of stress to which the critically ill patient is subjected acts as a trigger to stress cardiomyopathy. This review discusses the reseavch of current status in stress cardiomyopathy of critically ill patient.