Title: cardiogenic shock
题目：心源性休克
Author作者: Amal Mattu
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1. CS is most commonly secondary to a large MI where > 40% of the myocardium is involved; however mechanical, valvular, dysrhythmogenic, and infectious etiologies should also be considered: papillary or chordal dysfunction, free wall or septal defects disease, insuffiency of any valve, myopericarditis, endocarditis, Takotsubo, end stage cardiomyopathy, and tamponade.
心源性休克最常见于大面积（超过40％）的心肌梗塞；但同时还要考虑机械性，瓣膜，心律紊乱，和感染性原因：乳头肌和索条肌功能失调，心脏游离壁或室间隔缺陷，任何瓣膜功能不全，心肌心包炎，心内膜炎，压力诱导（Takotsubo）心肌病，晚期心肌病，和心包填塞。
2. Incidence of 5-10% STEMI and 2.5-5% NSTEMI

发病率占ST段抬高心肌梗塞病人的5－10％和非ST段抬高心肌梗塞的2.5－5％。
3. Mortality ~50%

死亡率约50％。
4. Immediate coronary reperfusion is the best treatment (NNT 8). Medical therapy is a distant second choice in management, with reperfusion and pressors as needed. Early intra-aortic balloon pump use is key.
紧急冠状动脉再通是首选的治疗手段（需要治疗的病例数－NNT为8）。包括择期再通和升压药在内的治疗方法都是次要的。早期主动脉内气囊反搏的应用是相当关键的。
5. Recent case reports have shown imporved outcomes when induced hypothermia was used in patients refractory to traditional therapy with pressors/inotropes/IABP.
最近有病例报告显示，对包括升压药／强心药／主动脉内气囊反搏等传统治疗方法无效的病人，诱发性低温会改善预后。
6. There are only a few interventions that have been demonstrated to improve outcomes: early use of intra-aortic balloon pump, stenting, and G2B3A inhibitors.
只有几个治疗方法能够改善预后：早期使用主动脉内气囊反搏，支架，和G2B3A抑制剂。
7. It is generally recommended to avoid clopidogrel since so many of these patients will require CABG.
通常建议不要使用氯吡格雷，因为很多这样的病人都需要冠状动脉搭桥术。
8. Early use of mechanical ventilation decreases work of breathing and improves oxygenation.
早期使用机械通气有助于减轻呼吸负荷和改善氧和。
9. Remember that age alone is not a contraindication to aggressive treatment.
要记住，年龄并不是积极治疗的禁忌症。