Reversible myocardial dysfunction after cardiopulmonary resuscitation
Reversible myocardial dysfunction after cardiopulmonary resuscitation
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DOI：
10.1016/j.resuscitation.2005.01.012
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发表时间：
2005-08-01
期刊：
影响因子：
6.5
通讯作者：
Fierro-Rosón, J
中科院分区：
文献类型：
--
作者：
Ruiz-Bailén, M;de Hoyos, EA;Fierro-Rosón, J
目的：急性冠脉综合征患者经常出现心肌顿抑。最近，它也被描述在没有缺血性心脏病的危重患者中。任何综合征中最严重的形式，导致心跳呼吸骤停，都可能导致心肌顿抑。心肌顿抑似乎已经在实验研究中得到证实，尽管这种现象在人体模型中还没有得到充分的研究。本研究的目的是研究和描述在没有急性或既往冠状动脉疾病的情况下，在心肺骤停后复苏的患者可能发生的心肌功能障碍。设计：一系列描述性研究。地点：一家省级医院的重症监护病房(ICU)。患者和参与者：研究时间为1999年4月至2001年6月。所有住进ICU的危重、无冠状动脉病变、无心脏病病史的患者以及那些在心肺骤停后复苏的患者都被纳入研究中。测量和结果：通过经胸和经食道超声心动图评估左心室射血分数(LVEF)和节段收缩功能障碍。这项研究是在入院后24小时内、第一周、第二周或第三周、第一个月后以及3-6个月之间进行的。29名患者的平均年龄为65岁(范围为24-76岁)。12名患者死亡。20名患者出现心肌功能障碍；这些患者的初始左心室射血分数为0.28(0.12-0.51)，存活的患者随着时间的推移表现出改善。所有患者均出现节段性收缩功能障碍，并随着时间的推移逐渐恢复正常。结论：心肺复苏成功后，可能会出现以收缩功能障碍和节段性收缩功能障碍为主的可逆性心肌功能障碍。(C)2005爱思唯尔爱尔兰有限公司。保留所有权利。
Objective: Myocardial stunning frequently has been described in patients with an acute coronary syndrome. Recently, it has also been described in critically ill patients without ischaemic heart disease. It is possible that the most severe form of any syndrome, leading to cardiorespiratory arrest, may cause myocardial stunning. Myocardial stunning appears to have been demonstrated in experimental studies, though this phenomenon has not been sufficiently studied in human models. The aim of the present work has been to study and describe the possible development of myocardial dysfunction in patients resuscitated after cardio-respiratory arrest, in the absence of acute or previous coronary artery disease.Design: Descriptive study of a case series.Setting: The intensive care unit (ICU) of a provincial hospital.Patients and participants: The study period was from April 1999 to June 2001. All patients admitted to the ICU with critical, non-coronary artery pathology, with no past history of cardiac disease, and those who were resuscitated after cardio-respiratory arrest, were included in the study.Measurements and results: Transthoracic and transoesophageal echocardiography was used to assess left ventricular ejection fraction (LVEF) and disturbances of segmental contractility. This study was carried out within the first 24 h after admission, during the first week, during the second or third week, after I month, and between 3 and 6 months. Twenty-nine patients with a median age of 65 years (range 24-76) were included in the study. Twelve patients died. Twenty patients developed myocardial dysfunction; the initial LVEF in these patients was 0.28 (0.12-0.51), showing improvement over time in the patients who survived. All of these patients presented disturbances of segmental contractility which also became normal over time.Conclusions: After successful CPR, reversible myocardial dysfunction, consisting of systolic myocardial dysfunction and disturbances of segmental contractility, may occur. (c) 2005 Elsevier Ireland Ltd. All rights reserved.