急性心肌梗死合并心源性休克的治疗进展  

Advances in the Treatment of Acute Myocardial Infarction Complicated by Cardiogenic Shock

作　　者：陈妍[1] 刘寅[1] CHEN Yan LIU Yin(Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, Chin)

机构地区：[1]天津市胸科医院心内科,天津市心血管病研究所,天津300222

出　　处：《医学与哲学（B）》2017年第4期63-66,共4页Medicine & Philosophy(B)

基　　金：2015年天津市科委计划项目(15ZXHLSY00320);2016年天津市科技支撑计划重点项目(16YFZCSY00800);2016年天津市科委计划项目(16ZXMJSY00150)

摘　　要：心源性休克(CS)是急性心肌梗死死亡的最主要原因。急诊再血管化治疗PCI或者冠状动脉旁路移植术(CABG)对于降低急性心肌梗死(AMI)合并CS的病死率有积极的意义。目前还没有哪个随机对照试验明确PCI或CABG哪种更好,但目前的治疗倾向于急诊PCI。合并CS的AMI患者直接多支血管PCI治疗获益增加。对于血压偏低的患者,去甲肾上腺素应该作为缩血管药物的一线选择。靶目标平均血压维持在65mmHg^70mmHg,因为更高的血压不增加临床获益。最佳的多器官功能不全综合征治疗是CS治疗的基石。经皮机械辅助装置临床应用逐渐广泛,可以提高冠状动脉的灌注,但也加剧炎症反应、出血等风险。Cardiogenic shock （CS） is the major cause of death in patients with acute myocardial infarction （AMI）. Emergency revascularization in CS, PCI or CABG , can reduce the mortality, while there are no randomized controlled trials for which is better, but current treatments tend to PCI. Direct multivessel PCI treatment increased benefit in patients with CS. For patients with low blood pressure, norepinephrine should be used as the first choice of vasoactive drug target. The average blood pressure was maintained at 65mmHg-70mmHg, because of the higher blood pressure does not increase the clinical benefit. Management of multiple organ function insufficiency syndrome is the best the cornerstone of CS. The Use of Mechanical Support Devices can improve coronary perfusion, but also increase the risk of inflammation, bleeding and so on.

关 键 词：急性心肌梗死 心源性休克 治疗进展 

分 类 号：R542.22[医药卫生—心血管疾病]