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是用泵还是不用泵?(To Pump or not to Pump?)
原作者: 肖锋译 文章来源: 中华急诊医学杂志编辑部 发布日期:2013-01-16

Title: To Pump or not to Pump?
题目:是用泵还是不用泵?
Author 作者: Haney Mallemat

Intra-aortic balloon pumps (IABP) are devices that provide hemodynamic support during cardiogenic shock; the balloon inflates during diastole (improving coronary artery perfusion) and deflates during systole (reducing afterload and improving systemic perfusion).
主动脉内气囊反搏(IABP)是在心源性休克用来提供血液动力学支持的设备。气囊在舒张期充气(改善冠状动脉灌注),在收缩期放气(减轻后负荷,以改善全身灌注)。
Several guidelines recommend placement of an IABP for patients in cardiogenic shock secondary to acute myocardial infarction (AMI), if early revascularization (e.g., CABG) is planned (Class I recommendation). Data behind this recommendation, however, is limited.
有几个临床指南都建议IABP在右急性心肌梗塞造成的心源性休克的使用,以过度到早期血管再通(如冠状动脉搭桥等,一级建议)。但是,支持这一建议的数据是有限的。
The IABP-SHOCK II trial was a randomized, multi-center, open-label study that enrolled 600 patients (598 in the analysis) with cardiogenic shock secondary to AMI (STEMI or NSTEMI). Patients were randomized to the control group (receiving standard therapy; N=298) or the experimental group (receiving IABP; N=300).
主动脉内气囊反搏-休克(IABP-SHOCK)II是一个随机的,多中心的,开放标签的临床研究,包括了600个(598个用于分析)由急性心肌梗塞(ST段升高或不升高)造成的心源性休克的病人。病人随机的分成对照组(接受标准治疗,298人)或实验组(接受IABP,300人)。
No significant difference was found between groups with respect to 30-day mortality (primary end-point), secondary end-points (e.g., time to hemodynamic stabilization, renal function, lactate levels, etc.), or complications (e.g., major bleeding, peripheral ischemic complications, etc.).
结果显示在30天死亡率(主要指标)或到血液动力学稳定时间,肾功,乳酸水平(次要指标),或合并症(大出血,末梢缺血)方面两组之间没有明显差别。
Bottom line: Perhaps it is time to reassess the approach to cardiogenic shock secondary to AMI when early revascularization is planned. At this time consultation with local expertise is recommended.
要点:对于有计划要接受早期在灌注治疗的急性心肌梗塞心源性休克的病人的抢救方案要急性从新的评估。到目前为止,还是要听取专家的意见。

References 参考文献
Thiele, H. et al. Intra aortic balloon support for myocardial infarction with cardiogenic shock. NEJM 2012 Oct 4;367(14):1287-1296.

文章来源:中华急诊医学杂志编辑部