目的:研究心脏外科手术的演变,重点关注患者日益增加的复杂性以及机械循环支持(MCS)在管理围手术期低心排血量综合征(P-LCOS)中的作用。
结果:P-LCOS是心脏手术患者死亡率的重要预测因子。术前危险因素,如心源性休克和乳酸水平升高,可以帮助识别风险较高的人。主动使用MCS,而不是P-LCOS开发后的反应性实施,可能通过预防严重的器官灌注不足来改善预后。“受保护的心脏手术”的新兴概念强调早期识别这些高危患者并计划使用MCS。此外,针对各种心脏病,正在开发和完善特定的MCS策略,包括AMI-CS,瓣膜手术,和肺血栓内膜切除术。
结论:本文探讨了心脏手术患者的人口统计学和复杂性的变化。它强调了积极主动的重要性,多学科方法识别高危患者并实施早期MCS以预防P-LCOS并改善预后。受保护的心脏手术的概念,涉及计划的MCS使用和共享决策,突出显示。本文还讨论了针对特定心脏程序量身定制的MCS策略以及围绕MCS实施的伦理考虑。
OBJECTIVE: To examine the evolving landscape of cardiac surgery, focusing on the increasing complexity of patients and the role of mechanical circulatory support (MCS) in managing perioperative low cardiac output syndrome (P-LCOS).
RESULTS: P-LCOS is a significant predictor of mortality in cardiac surgery patients. Preoperative risk factors, such as cardiogenic shock and elevated lactate levels, can help identify those at higher risk. Proactive use of MCS, rather than reactive implementation after P-LCOS develops, may lead to improved outcomes by preventing severe organ hypoperfusion. The emerging concept of \"protected cardiac surgery\" emphasizes early identification of these high-risk patients and planned MCS utilization. Additionally, specific MCS strategies are being developed and refined for various cardiac conditions, including AMI-CS, valvular surgeries, and pulmonary thromboendarterectomy.
CONCLUSIONS: This paper explores the shifting demographics and complexities in cardiac surgery patients. It emphasizes the importance of proactive, multidisciplinary approaches to identify high-risk patients and implement early MCS to prevent P-LCOS and improve outcomes. The concept of protected cardiac surgery, involving planned MCS use and shared decision-making, is highlighted. The paper also discusses MCS strategies tailored to specific cardiac procedures and the ethical considerations surrounding MCS implementation.