微轴流量或在心脏病发作相关的心脏性休克时的标准护理
Jacob E Møller1, Thomas Engstrøm1, Lisette O Jensen1
1From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.).
使用微轴流量的临时机械循环支持,在ST段升高心肌梗塞患者心脏性休克时降低了死亡率. 然而,与单独的标准护理相比,这种方法增加了不良事件的风险.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 关键护理医学 关键护理医学
背景情况:
- 微轴流对ST段升高心肌梗塞 (STEMI) 与心脏性休克的疗效尚未得到充分证实.
- 暂时的机械循环支持旨在改善高风险心脏病患者的治疗结果.
研究的目的:
- 评估微轴流量 (Impella CP) 加上标准护理与单独标准护理对心脏性休克STEMI患者180天死亡率的影响.
- 评估与微轴流量使用相关的安全概况,包括组合的不良事件.
主要方法:
- 这是一项国际性的多中心随机试验,涉及355名患有STEMI和心脏性休克的患者.
- 患者被分配给接受微轴流量 (Impella CP) 标准护理或单独标准护理.
- 主要终点是180天内全因死亡;综合安全终点包括严重出血,四肢缺血,血液溶解,器件故障或恶化大动脉吐.
主要成果:
- 180天后所有原因的死亡率在微轴流量组 (45.8%) 与标准护理组 (58.5%) 相比较较低,危险率为0.74 (95% CI,0.55到0.99;P=0.04).
- 在微轴流量组中,复合安全终点事件发生在24.0%的患者中,而在标准治疗组中为6.2% (相对风险,4.74).
- 替代疗法的发生率在微轴流量组 (41.9%) 与标准治疗组 (26.7%) 相比较高.
结论:
- 与标准护理相比,常规使用微轴流量与STEMI相关心脏病性休克的标准护理一起,可显著降低180天死亡率.
- 使用微轴流量与较高的复合不良事件发生率有关.
- 可能需要进一步的研究,以优化机械循环支持在这个患者群体的使用.
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