Cập nhật trong Quản lý Bệnh Nhân Hội Chứng Tim Tâm Phế cấp Tính

Current Cardiology Reports - Tập 21 - Trang 1-10 - 2019
Jayant Bagai1, Emmanouil S. Brilakis2
1Vanderbilt University Medical Center, Nashville, USA
2Minneapolis Heart Institute, Abbott Northwestern Hospital, and Minneapolis Heart Institute Foundation, Minneapolis, USA

Tóm tắt

Chúng tôi cung cấp một bản cập nhật ngắn gọn về quản lý hiện tại của hội chứng tim tâm phế cấp trong bối cảnh hội chứng vành cấp tính (ACS). Nhận diện kịp thời hội chứng sốc, lựa chọn và khởi động tối ưu hỗ trợ tuần hoàn cơ học (MCS), tái tưới máu vành sớm, và tiếp cận dựa trên nhóm, theo quy trình là những trụ cột hiện tại trong quản lý. Hội chứng tim tâm phế cấp làm phức tạp khoảng 5–10% các trường hợp ACS và tiếp tục có tỷ lệ tử vong cao. Việc sử dụng sớm hỗ trợ tuần hoàn cơ học có thể ngăn ngừa vòng xoáy tiêu cực của sốc và đã tăng đáng kể theo thời gian, chủ yếu được hỗ trợ bởi dữ liệu từ các cuộc đăng ký. Trong thử nghiệm CULPRIT-SHOCK, việc tái tưới máu chỉ tại các mạch bệnh lý đã liên quan đến tỷ lệ tử vong hoặc suy thận nặng do bất kỳ nguyên nhân nào thấp hơn trong 30 ngày, so với can thiệp mạch vành đa mạch ngay lập tức. Vì vậy, việc tái tưới máu định kỳ các tổn thương mạch không liên quan đến nhồi máu trong quá trình can thiệp mạch vành cho hội chứng tim tâm phế cấp là không được khuyến cáo. Việc sử dụng thường xuyên bơm bóng trong động mạch chủ (IABP) không liên quan đến việc cải thiện kết quả trong thử nghiệm IABP-SHOCK II. Một tiếp cận dựa trên nhóm và theo quy trình có thể cải thiện thêm kết quả. Những tiến bộ gần đây trong tái tưới máu vành và sử dụng MCS, thực hiện các đội sốc và các quy trình tiêu chuẩn hóa có thể cải thiện kết quả của hội chứng tim tâm phế cấp ở bệnh nhân ACS.

Từ khóa

#hội chứng tim tâm phế #quản lý hội chứng vành cấp tính #hỗ trợ tuần hoàn cơ học #tái tưới máu vành #tỷ lệ tử vong #can thiệp mạch vành đa mạch

Tài liệu tham khảo

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