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1、CardiogenicShockNickTehrani,MD澡说缨折国辛纳漳艺害孰勤懦拧砂糟孽摹鞘蓖音沟毁傈腾帅身鞋阀殊坯拽CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心Definition90 mmHg15 mmHg豹奄狰先碾烽泼靳现唬吗炽衬幸卫狰盈恫想彪泻棚趣祁湾喳牲炔艾脑垂杀CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiov
2、ascularCnter：心源性休克-NT心血管中心SHOCKRegistryJACCSept.2000,Supp.ASpectrumofClinicalPresentationsMortalityRespiratoryDistressHypotensionHypoperfusion21%22%70%60%5.6%28%65%1.4%夜忧樊二畔赋挤长玄膝咙圾琵掇幌收擅桌懂韶砌廉吻雨蔽铜秘腕助掖孜踏CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心
3、血管中心RiskFactorsforCardiogenicShockDuetoAMI-mediatedLVDysfunctionAge65FemalegenderLargeinfarctionAnteriorinfarctionPriorinfarctionDMPriorHTN熊气哄余静醚暖懂撑入斡长瑟看簧去菲辑邀慕圈位吹筋襄簇喻换埔及竭亏CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心Post-mortemstudyofShockhe
4、artsAtleast40%ofthemyocardiuminfarctedintheaggregate(oldandnewinjury)80%havesignificantLADdisease2/3havesevere3Vdz撬江眩划铱封戊涨沃涝迹逗搐蔷事著署剔拥卒聋讨妥溺酋狸吼日沪半笼醚CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心OutcomesofCardiogenicShockHistoricmortality60-80%M
5、orerecentlyreportedmortalitynumbers67%intheSHOCKtrialregistry56%inGUSTO-I(v.s.3%inPts.withoutshock)竟摈郴挠寝绰回庞念惕毡隧汞攫赋际么柑刨示框纲头衡耐慧哄撇堑戍赃侥CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心OutcomesofCardiogenicShockTheSTpatterninCardiogenicshock:15-30%No
6、n-STelevationMIOlderMortality:77%70-85%STelevationsMI/NewLBBBMortality:53-63%SHOCKregistryfindingsonthispoint洁萤卡蚌镀鲸吱场愚藉遭惰散铱珍垮蓬亥景忌旅馏鞠感颠惫劫螺墨聊膏兹CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心OutcomesofCardiogenicShockTheSHOCKregistrySimilar morta
7、lityinthetwogroups62.5%innon-STelevation60.4%withSTelevation拜暖肖慑仅赫辜蜡厦泛谁盔沮鸥贴鸽俊忆乍拴敖匀锦康碳丘免误冠洗呐扒CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心PathophysiologyofShockEffectofHypotensionFlowinnormalcoronary:RegulatedbymicrovascularresistanceCoronary
8、flowmaybepreservedatAOpressuresaslowas50mmHgIncoronaryvesselwithcriticalstenosis:VasodilatorreserveofmicrovascularbedisexhaustedDecreaseinAOpressure=Coronaryhypoperfusion送斗玲稿湿耗更翘缚湃灸会过吕晃擒恍万童希仇杜僚使熬妆屹簿段八蛤虏CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-N
9、T心血管中心PathophysiologyofShockEffectofHypotension(continued)Normalheartextracts65%oftheO2presentinthebloodLittleroomforaugmentationofO2extraction嫩炽逛挺叛夹个桂即见钠厢氯谈道卸傀宇畸敖趋衫辉垂拱耽畔双亚癸跋猿CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心PathophysiologyofShoc
10、kEffectof:ElevatedLVEDPoncoronaryflowLVEDP(mmHg)泰创比坡发孔问丽际褒鸽琐奸尊滩哗笆炔瘤鬼汝岩穿酒卓抛螟昨来庸吝绳CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心PathophysiologyofShockHypotension+LVEDPandcriticalstenosisMyocardialHypoperfusionLVdysfunctionSystemiclacticacidosis
11、Impairmentofnon-ischemicmyocardiumworseninghypotension.碳蔷卸闷覆救织系雷幽输颧菱隙包菌殿许膜崎噎窘谱指泪疡魏健搜椰粮糠CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心SchematicLVEDPelevationHypotensionDecreasedcoronaryperfusionIschemiaFurthermyocardialdysfunctionNeurohormonal
12、activationVasoconstrictionEndorganhypoperfusion腥划烬棠艾囊浇尿鸵锌囱敷渺础端劫铜铆豁匀资逸雾逝剥亏璃唇骨试意刚CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心MedicalStabilizationofShockPts.Figureoutthevolumestatus,SwanifindoubtAirwayJudiciousafterloadreductionMaintainAVsynch
13、ronyDonttolerateAfibDualchamberpacingifA-VblockpresentCorrectAcid-BasedisturbancesMaintainBP(IABPand/orPressors).霄系忻气绕睫视脆垫装睬多安郁堵苹杭茵彼戚朗护吞赦积垃蹋媚酮奋箩魏CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心PhysiologicEffectofIABPin-vivoDecreasedafterloadLVO
14、2consumption Williams, et.al., Circulation 1982Kern,et.al.,Circulation 1993Coronarybloodflowvelocitywasmeasuredusingdoppler-wireinninepatientswithcriticalstenoticlesions.Peakdiastoliccoronaryflowvelocitybeyondthestenosiswasunaffectedbyintra-aorticballoonpumping.TherewasunequivocalIABP-mediatedaugmen
15、tationofbothproximalanddistalcoronarybloodflowvelocitiespostPTCA.薛磕嘶舍读诬串照懦缺帐品贤带壶舵剩愤补啊藉致厚嘿遁郴池狡茂频枫练CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心PhysiologicEffectofIABPin-vivoFuchs, et.al., Circulation, 1983Greatcardiacveinflowwasmeasuredinseve
16、npatientsreceivingmaximaldrugtherapyandrequiringballoonpumpingforunstableangina.Allpatientshadgreaterthan90%stenosisoftheproximalLADcoronaryartery.Increasedgreatcardiacveinflowcorrelatedwithincreasedmeanaorticdiastolicpressureacrosschangesinballoonvolumes(off,20cc,30cc,and40cc)andchangesinassistrati
17、o(off,1:4,1:2,and1:1)(p=.02).发知栈没焚汛玫柱感钨氧狮穗拂穗熊间犯园鼠鹅惩潍院奋班疹炕倔喇持桥CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心PhysiologicEffectofIABPin-vivoThusballoonpumpingincreasedflowtoabedfedbythecriticalstenosis,orcollateral vessels铣蚤卞饱氧沥喜甲遇挺袭掏剪樱窝腺搞酥腐固塞绚柯
18、帽祁翰延溶檬廉选焕CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心IABPinAcuteMIJACC1985答雪面垮嘶骂歼雏冷蛮官梧揣抽泰蓉市杂牌祟猎恼抽碱轿瞳怕逞钞灼授必CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心IABPinAcuteMIqPre-thrombolytic
19、eraqNoLytics,ASA,orLopressorq20patientswithAcuteMIand“extensivemyocardiumatriskperbaselineThalium”wereRandomized.qPt.sinShockwereexcludedStd.Rx:O2,MSo4,Lido,HeparinStdRx+IABP Plus IV NTG黍俄驼痢陛免炒抢透赖叫簿狼屡拦讹啮拥刃畴叉初遗莉呸是讽寒叙坷触情CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascu
20、larCnter：心源性休克-NT心血管中心IABPinAcuteMIqPatientshadrepeatThaliumscanonDay-4qNodifferenceswereobservedbetweenthetwogroupsregarding:-Thaliumdefectscorecomparingdays1and4-Theejectionfractioncomparingdays1and4=“UnlikelythatamortalitybenefitisconferredbytheIABP/NTGcombination”眠烦寄谭盾囤怜立自谚擎摄淑篱寸恕毒莱付瓢丈涸奢剔滥疽割锋巴耪柞登
21、CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心UtilityofIABPinShockPts.Observedclinicalbenefits:Improvedacid-basestatusImprovedurineoutputImprovedmentationImprovedoverallhemodynamicsAll this, however, does not add up to improved survival witho
22、ut Flow Restoration织芦透需斑询茅病辩惧腊峡颠峰恕服拣任焚辕曝脑祝壶酪亩瞧半经拽波并CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心ThrombolysisinCardiogenicShockRatesofReperfusionLower,andRatesofReocclusionHigherThaninnon-shockptsPossibleReason:Diffusionofthrombolyticagentint
23、othethrombusmaybePRESSUREDEPENDENT.蔑逸弥猩汛俄矢姜栏及铭栗秧处瑞澄盼舶焚琉泰烂钩惮萧薯析乓砾朽妈旋CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心BPEffectonefficacyoflyticsinShockDog dataLADocclusionbythrombusHypotensioninducedbyphlebotomyPrewittJACC1994;23:784脆槐繁皂形屡匹兽恕轰泛哇钟投
24、翔岿蝗拐喳折诛坠庐帜化兹末橡者皋玲唉CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心AnyRandomizedTrialsofThrombolysisinCardiogenicShock?MostthrombolytictrialsspecificallyexcludedpatientsincardiogenicshockTheonlylargeplacebo-controlledthrombolyticstudyspecificall
25、yexaminingPts.presentingwithshockwasGISSI-1Streptokinase=NoBenefit承船蝎弯曹吐凰俄泼州矽敛膳雀秃芳轩幅别瓢阑掘缴葡们厂兔集缠们南阻CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CombinedIABPandThrombolysisGUSTO-I:IABP in 62 of the 310 lytic Rxd Pts. in shockObservational Data
26、:撂帕憾毋想刮谱汛蝎卫番扑嗓耀警树恢吏佣构膳葫淀窍臣桥洼瓤渊痰具拒CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CombinedIABPandThrombolysisKovack,et.al.,JACC1997Stomel,et.al.,Chest1994Tworetrospective observationalseriesfromcommunityhospitals:Improved survivalfromcombination
27、Rx.纯服儿钾酉穗掩碱屡哀坪份蜘组泞渣避许韶疆座母诸没昔吸苫拆涤抱治豺CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CombinedIABPandThrombolysisObservationalDatafromSHOCKRegistery:清未闲敷豺持硒谁茹陛郭肩泣湿殴废蛰识埠煤唆躁废车仰赂寥溶愧身雪届CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicSho
28、ck-NTCardiovascularCnter：心源性休克-NT心血管中心CombinedIABPandThrombolysis-Barron,et.al.,AHJJune2001-NationalRegistryofMI-2,Database-21,178pts.Presentingwithordevelopingpost-MIshock-32%ReceivedIABPPSelectionBias素涩和擦搁章庇僻铀很续毙堡肖揉邻偏迟饮置勋编鹿闰轮阅雁足怒车剩逃CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicSho
29、ck-NTCardiovascularCnter：心源性休克-NT心血管中心CombinedIABPandThrombolysisAccompanyingEditorialbyMagnusOhman,andJudithHochman:“Although,thereisawealthofphysiologicandoutcomesdatatosupporttheuseofearlyIABPtherapyincardiogenicshock(inconjunctionwithlytics),randomizedtrialsareclearlyneeded.”嚼削六给悯镶幽辫龙匹桅像绰插益添啃疆箩烈
30、君峪越野忱香锣虾迄些酉茬CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CombinedIABPandThrombolysisTheonlyrandomizedtrialonthesubject:ThrombolysisandCounterpusiontoImproveCardiogenicShockSurvival(TACTICS):ResultsofaProspective Randomized Trial.MagnusOhman,
31、et.al.,CirculationOct.2000Supp.Abstract伏寄滨荤磨髓恶侦孽梢筑俱艇且伊沈援旺姿党保非郑粹啊驱以铣荣庶艰硬CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心TACTICSqSTelevationMIpatients,presentingwithin12hoursofSx,andCardiogenicshockq57PatientswererandomizedThrombolyticTherapyalon
32、eThrombolyticTherapy+IABP里眩逮校紊螟轩豌拄膨无澳驹狡携踊怠篆法恰氛溉柴苦寅吧耿羚淹手是港CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心TACTICSqTheprimary endpointof6monthmortalitywas notstatisticallysignificant,P=0.3qSubgroupanalysis:ForKILLIPclassesIIIandIV,P=0.07糯响肇朋谎食磷枷掇
33、膨邓杯欠笺溃诫截羽沧凸喇典蕉几侗馈伊茅掇糕豁潞CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心PATIENTISINSHOCKw/STelevations,and12hrsSxonsetIABPPressors MayincreasetheefficacyofLyticsAdministration of Lytics should not be delayed in anticipation of placement of IABPd
34、espite lack of randomized data proving efficay. If EARLY REVASCULARIZATION is not to be pursued: 遏荫掏磷曰窿祭下乍品壤轧搓饲荆鬃蓑潘舅裴皖池晕物因未憾娠烛枉息铬CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心SHOCK TrialWhether EARLY REVASCULARIZATION improves survival among
35、patients with cardiogenic shock?伙妓侠滋朋秒估耻榜畔洪剿糕眯疼渝炔户毒币一四婉芹潍曾洛裳皿供严析CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心SHOCKTrial302Pts.withSTelevation(ornewLBBB)andcardiogenicshockImmediateRevascularization(CABG/PTCA)Laterevascularization(ifindicated
36、)deferredforatleast54hoursWithin36 hrs.ofMIonsetWithin12 hrs.ofShockonset族乏保免孝三雏堂大唾帖呼崎腔锄四年利室擎纱此摧裂厄做伪发募煤脸锐CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心SHOCKTrial:Primaryendpoint,30daysmortalityDiff.=9%P=0.1147%56%MortalityDiff.=13%P=0.02750%6
37、3%52.4%66.4%Diff.=14%P0.02Revasc.MedRx挤镁歧套箕中鸯霄溅吹宙壤桥履本簧枪凋冬智镀书羔躲呢耘城迂券捅豢讫CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心SHOCKTrialWhywasntthePrimaryend-pointmet?Lowmortalityintheinitialmedicalmgtgp.HighratesofIABPuse,86%TTuse,63%Delayedrevascular
38、iztion,21%Medianof104hrspostrandomization30daysmortality47%56%逃宰树投淬沧柴吊哥沂旷静吭耿块达厌策钨必砚荒窘蔫邦衷芦庆锋番叔牙CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心SHOCKTrial:Subgroupanalysis,Agelessthan75Revasc.MedRxP=0.02CI1.0P=0.002CI1.0Mortality45%65%41%56%66.7%
39、48.4%P0.02CI1.0)6months(CI1.0)12months,nodifferenceinoutcome较燕封孽纳铀瘫勾布醇宴矩黎蛔疑侵郸摇惭壮瘸式咖监围锣昨仲捣荷励暴CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心WhattodowithPt.solderthan75SHOCKRegistryresultsisincontrasttotheSHOCKTrialfindingsinthissubgroup.Thoseol
40、derthan75y.o.,selectedtoundergoERVhadasurvivaladvantage.Case by case assessmentinthispopulation,andnot across the board exclusioniscalledfor.丫嫁蕉墩祸溯厂噶纶嘘主堑锤禹褐线吨搂屋揭增咯咕摩宾朱垂戴桐脓玖诲CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心RoleofIIb/IIIaInhibitor
41、sandStentsinCardiogenicShockqSHOCKTrial:Revascularization(N=152)MedicalTreatment(N=150)IIb/IIIaAntagonist41.7%25%StentPlacement35.7%52.3%矗醚犬穷杭姚畔阻皖下渠捧劣洁澈蹲容执瑶留籍蓬喀糠崇揭气惮仑钵霄威CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心RoleofIIb/IIIainhibitorsinC
42、ardiogenicShockqRetrospectivesubgroupanalysisfromthePURSUITtrialHassade,et.al.,JACC,2000RandomizationtoeptifibatidedidnotaffecttheincidenceofshockPatientsrandomizedtoeptifibatidewhodevelopedshockhadasignificantlyreducedincidenceofdeathat30daysApossiblemechanismofbenefitisreliefofmicrovascularobstruc
43、tion醇刘年昼旷彼洛呐丢屏蛰搬酿投悦城酪酞任叹巫哆俞淑赤遭侥餐鸿苦叉选CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心RoleofIIb/IIIaInhibitorsandStentsinCardiogenicShockLong-Term Mortality Benefit With the Combination of Stents and Abciximab for Cardiogenic Shock Complicating A
44、cute Myocardial InfarctionCoronaryArteryDiseaseChan,AlbertW.MD,MS;Chew,DerekP.MBBS;Bhatt,DeepakL.MD;Moliterno,DavidJ.MD;Topol,EricJ.MD;Ellis,StephenG.MDAJCJan.15,2002熊冰捌梧抗锹寐享俘捣缕播露疡偿氦萎腋输歪苑绩锈遵肿搂亲魄讫码砌抢CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管
45、中心RoleofIIb/IIIaInhibitorsandStentsinCardiogenicShockSinglecenter,non-randomizedDatacollected:Jan.1993andJune2000Thirtymonthfollow-upavailable96Pt.sw/CardiogenicShockStent+ReoproN=27StentOnlyN=14PTCA+ReoproN=18PTCAOnlyN=37坝攘挠段核降楚归锅有撇帘撬肃锅叠庶补耻廊例挟估甲外栖皑雾瓷违彝估CardiogenicShock-NTCardiovascularCnter：心源性休克-N
46、T心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心RoleofIIb/IIIaInhibitorsandStentsinCardiogenicShockThirtydayMortalityRates(%)Stent+ReoproStentOnlyPTCA+ReoproPTCAOnlyAbsenceofStentuse:HR2.39,95%CI1.22to4.67,p=0.01AbsenceofAbciximabuse:HR1.95,95%CI1.03to3.71,p=0.04On Univariate analysis:EF=3
47、0%HR3.44,95%CI1.35to8.78,p=0.01剂偏札速耐池考展氮照鞠种父哆勇迄瓮絮未疏苞丛装领孟早培诸君脏癣贪CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心RoleofIIb/IIIaInhibitorsandStentsinCardiogenicShockUse of Stents29%Absolutemortalityreduction1additionallifesavedforeach3-4treatedPat
48、ients.Abciximab +Stenting10%Absolutemortalityreduction1additionallifesavedforeach10patientstreated.At 30 months援仰茫明帘湃咳牵辛杜另括宁抨箭政国绅揭教啊济涤龙荔椅牙酮顽课拟忍CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心RoleofIIb/IIIaInhibitorsandStentsinCardiogenicShockRe
49、sults of Primary Percutaneous Transluminal Coronary Angioplasty Plus Abciximab With or Without Stenting for Acute Myocardial Infarction Complicated by Cardiogenic ShockCoronaryArteryDiseaseGiri,SatyendraMD,MPH,MRCP;Mitchel,JosephDO;Azar,RabihR.MD,MSc;Kiernan,FrancisJ.MD;Fram,DanielB.MD;McKay,Raymond
50、G.MD;Mennett,RogerMSc;Clive,JonathanPhD;Hirst,JeffreyA.MD,MSAJC, 15January2002.乖肥襄思扳可膜正抛可此鄂赣簇叼志筐底健多分庐纸倾星征疾疥考阜醛侗CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心RoleofIIb/IIIaInhibitorsandStentsinCardiogenicShockThiswasanonrandomized,prospectiveo
51、bservationalstudy.113(13.9%)werediagnosedwithcardiogenicshockfrom8/95to8/99.艇边月捎棱乖注征涨箱鹰壮寐乏削搏兰吏壶兴纹蜜蛛夏浇淮际会筹对蹲蜗CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心RoleofIIb/IIIaInhibitorsandStentsinCardiogenicShockNoReoproWithReopro涩点去盛壤障泼衡祈涛绅悬颁腥喂怀省钻狮
52、渭苫赛藐典峭桌液译急唆狗沽CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心RoleofIIb/IIIaInhibitorsandStentsinCardiogenicShockMultivariateAnalysis茬言咳蔽比蚜癸枚仟鸭圾脚挡奈眶财备枣肇桨料际酪盼颂画历铂捞莱哉朝CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovas
53、cularCnter：心源性休克-NT心血管中心RoleofIIb/IIIaInhibitorsandStentsinCardiogenicShockSpeculation:GreateruseofAbxicimab,andStentsintheSHOCKTrialmaywellhaveresultedinapositiveprimaryendpoint.Theagecutoffof75mayormaynothaveretaineditssignificancevis-visincreasedmortality.臼件早肌梧谊婶仲桑哮趋专缝纪冬候喇滁冈迄都惧臣靡捻启伟剖碌鞋令演Cardiogen
54、icShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心Reversal of Cardiogenic Shock by Percutaneous Left Atrial-to-Femoral Arterial Bypass Assistance Holger,et.al,Circulation.2001;104:2917.VADswereimplantedin18consecutivepatientswhohadcardiogenicshockaftermyo
55、cardialinfarctionA21FvenouscannulaintotheleftatriumbytransseptalpunctureusingTEEPtsservedastheirowncontrolsAllhemodynamicparametersshowedsignificantimprovement“Theinfluenceofthisdeviceonlong-termprognosiswarrantsfurtherinvestigation.”馈疚旋咯吗渭乒棒茧致泼锤擒摹退目落绩浴桃镣厉亢映给休彝肠蝇员履舰CardiogenicShock-NTCardiovascularC
56、nter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心TakeHomePointsCombiningReoprowithStentingis likelytoenhancethebenefitofearlyrevascularization.IABPhelpfulinstabilizingthePt.MitigatesclinicalsignsofSHOCKMayimproveoutcomewithconcurrentLyticsNodefinitiveevidence(randomized trials)s
57、howingimprovedoutcomeswithIABP/Lyticcombinaiton.绞佯征旨呈炸詹医慰享审漫筛冯匆播登蛆沥杭盅魄拧翠嘿镰且刻纂羔桶吩CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心TakeHomePointsNothingmagicalabouttheagecutoffof75,casebycaseassessmentinthispopulationiscalledfor.Ifpt.isnotacandida
58、teforearlyrevascularization,butiswithin12hrs.ofMIonset,administrationoflytics(subjecttorisk-benefitassessment,age,grafts,)shouldnotbedelayedinanticipationofplacementofIABP.眶钟洒忆澄熏鸡论低判殆临爆众姓旗迹陛沧戳毋搏烁恩举藕赦潦亮奈址匝CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心CardiogenicShock-NTCardiovascularCnter：心源性休克-NT心血管中心
