嗜铬细胞瘤诱发的心源性休克的体外生命支持：系统评价。,Perfusion

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嗜铬细胞瘤诱发的心源性休克的体外生命支持：系统评价。
Perfusion ( IF 1.1 ) Pub Date : 2020-05-01 , DOI: 10.1177/0267659120908413
Matteo Matteucci _{1,

2} , Mariusz Kowalewski ₃ , Dario Fina _{1,

4} , Federica Jiritano _{1,

5} , Paolo Meani ₆ , Giuseppe M Raffa _{1,

7} , Ibrahim Aldobayyan ₁ , Cesare Beghi ₂ , Jos Maessen _{1,

8} , Roberto Lorusso _{1,

8}

Affiliation

引言嗜铬细胞瘤是一种分泌儿茶酚胺的肿瘤，其临床表现从阵发性高血压到顽固性心源性休克。在静脉-动脉模式下，体外生命支持在难治性急性心脏功能障碍中的应用正在全球范围内急剧增加。但是，其在嗜铬细胞瘤引起的心源性休克中的临床应用仍不清楚。方法根据系统评价和荟萃分析声明的首选报告项目，对发布的报告进行系统的评价。搜索已在PubMed，Embase和Google Scholar上完成，以找出描述在嗜铬细胞瘤诱发的心源性休克背景下使用体外生命支持的文章（PROSPERO：CRD42019125225）。结果35份报告，包括62例因难治性嗜铬细胞瘤危机而获得体外生命支持的患者，用于分析。几乎所有的受试者都进行了外周插管以获取体外生命支持。机械循环支持的中位时间为5天，大多数患者恢复了正常的心肌功能（左心室射血分数⩾50％）。住院生存率为87％。在10名患者（16％）的体外生命支持中，通过手术去除了嗜铬细胞瘤，而在血流动力学稳定和从机械支持中撤离后，其余患者被手术去除。结论成功地处理嗜铬细胞瘤引起的心源性休克取决于对休克的迅速认识和及时治疗。在这种情况下，

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Extracorporeal life support for phaeochromocytoma-induced cardiogenic shock: a systematic review.

INTRODUCTION Phaeochromocytoma is a catecholamine-secreting tumour associated with clinical presentation ranging from paroxysmal hypertension to intractable cardiogenic shock. Extracorporeal life support, in veno-arterial mode, application in refractory acute heart dysfunction is sharply increasing worldwide. However, its clinical utility in phaeochromocytoma-induced cardiogenic shock remains still unclear. METHODS A systematic review of published reports was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement. Searches were accomplished on PubMed, Embase and Google Scholar to identify articles describing the use of extracorporeal life support in the setting of phaeochromocytoma-induced cardiogenic shock (PROSPERO: CRD42019125225). RESULTS Thirty-five reports, including 62 patients supported with extracorporeal life support because of intractable phaeochromocytoma crisis, were included for the analysis. Almost all the subjects underwent peripheral cannulation for extracorporeal life support. The median duration of the mechanical circulatory support was 5 days, and most of the patients recovered normal myocardial function (left ventricular ejection fraction ⩾50%). In-hospital survival was 87%. Phaeochromocytoma was removed surgically during extracorporeal life support in 10 patients (16%), while in the remaining after haemodynamic stabilization and weaning from the mechanical support. CONCLUSION Successful management of phaeochromocytoma-induced cardiogenic shock depends on prompt recognition and immediate treatment of shock. In this scenario, extracorporeal life support may play a significant role allowing cardiac and end-organ recovery and giving time for accurate diagnosis and specific treatment.

更新日期：2020-05-13

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