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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,1,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,机械循环支持与心原性休克case,机械循环支持与心原性休克case机械循环支持与心原性休克case病例简介心电图：窦性心动过速，下侧壁导联ST段抬高。,机械循环支持与心原性休克case机械循环支持与心原性休克ca,1,病例简介,心电图：窦性心动过速，下侧壁导联,ST段抬高,。,病例简介心电图：窦性心动过速，下侧壁导联ST段抬高。,2,病史简介,胸部,CTA,：双侧胸腔少量积液，未示肺栓塞表现。,床旁经胸超声心动图：大量心包积液，下腔静脉,扩张,，右心房和右心室（RV）舒张期塌陷。,LVEF,目测估计为45至50。,冠状动脉造影：正常。,病史简介胸部CTA：双侧胸腔少量积液，未示肺栓塞表现。,3,病例简介,左右侧心导管检查结果,(Table,1,),病例简介左右侧心导管检查结果(Table 1),4,病例简介,由于,大量心包积液,导致的,舒张期压力,上升，,尽管升压药物剂量快速增加但患者,仍然,出现,日益恶化的酸中毒，持续,的,低血压和心动过速,。于是病人被送往手术室行心包开窗术以治疗心包填塞。,尽管,心包开窗术,成功，但术中患者休克状态恶化，给予紧急安置IABP。随后患者在初诊后,24,小时内被转运至哥伦比亚大学医学中心心血管科进一步诊治。,到达中心时患者血压,83/63,（,70,）,mmHg,，窦速,130bpm,，尽管,1,：,1IABP,支持下血压可充至90,mmHg,，并已给予米力农0.25,g,/,K,g,min和去甲肾上腺素15,g,/,K,g,min静滴，但,4小时之前,病人的尿量已经减少到15cm,3,/h，留置的Swan-Ganz肺动脉漂浮导管提示增高的充盈压和低心输出量(Table 2)。,考虑给予机械辅助循环支持治疗。,病例简介由于大量心包积液导致的舒张期压力上升，尽管升压药物剂,5,病例简介,病例简介,6,病例简介,病例简介,7,病例简介,病人被送往,手术室行,CentriMag BIVAD植入，同时行心内膜心肌活检送病理检查。术中经食道超声心动图显示小心腔，,LVEF50% with medical therapy (Class II; Level of Evidence B),Current Recommendations for MC,22,Current Recommendations for MCS,HFSA comprehensive HF practice guidelines：,Patients awaiting heart transplantation who have become refractory to all means of medical circulatory support should be considered for an MCS device as a BTT (Level of Evidence B),Permanent mechanical assistance with an implantable LVAD may be considered in highly selected patients with severe HF refractory to conventional therapy who are not candidates for heart transplantation, particularly those who cannot be weaned from intravenous inotropic support at an experienced HF center (Level of Evidence B),Current Recommendations for MC,23,Current Recommendations for MCS,HFSA comprehensive HF practice guidelines：,Patients with refractory HF and hemodynamic instability and/or compromised end-organ function with relative contraindications to cardiac transplantation or permanent MCS expected to improve with time or restoration of an improved hemodynamic profile should be considered for urgent MCS as a bridge to decision; these patients should be referred to a center with expertise in the management of patients with advanced HF (Level of Evidence C),Current Recommendations for MC,24,Current Recommendations for MCS,Canadian HF guidelines：,MCS may be offered to selected individuals with end-stage heart failure who are inotrope dependent and do not meet the traditional criteria for cardiac transplantation (Class IIb; Level of Evidence B),Current Recommendations for MC,25,Current Recommendations for MCS,ESC guidelines 2008/2010：,Current indications for LVADs and artificial hearts include bridging to transplantation and managing patients with acute, severe myocarditis (Class IIa; Level of Evidence C),Although experience is limited, these devices may be considered for long-term use when no definitive procedure is planned (Class IIb; Level of Evidence C),LVAD may be considered as destination treatment to reduce mortality (Class IIa; Level of Evidence B),Current Recommendations for MC,26,Thank You,世界触手可及,携手共进，齐创精品工程,Thank You世界触手可及携手共进，齐创精品工程,27,
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