【摘要】 心源性休克（cardiogenic shock,CS）是指由于心脏泵血功能受损导致心脏无法向全身组织输送足够量的血液，从而无法满足组织代谢需求的临床综合征。临床上，主要由急性心肌梗塞（acute myocardial infarction,AMI）与急性失代偿心力衰竭（acutely decompensated heart failure,ADHF）引起。近年来，随着人口老龄化进程加速，老年人心源性休克发病率逐年增加，其中急性失代偿心衰相关性心源性休克（heart failure related CS,HF-CS）取代急性心肌梗死后心源性休克（acute myocardial infarction complicated by cardiogenic shock,AMI-CS），成为老年心脏急重症人“最后战场”。尽管缺乏高质量循证医学证据，机械循环辅助（mechanical circulatory support,MCS），如静脉动脉体外膜氧合（venoarterial extracorporeal membrane oxygenation,V-A ECMO）在心源性休克患者中的应用越来越多。但心脏移植和持久左心室辅助设备在老年心源性休克的应用仍是禁区。为此，2024年2月26日，美国心脏协会（AHA）于Circulation发表针对老年CS的科学声明：(1)年龄是老年心源性休克的高危险因素，但不是唯一，不应用于指导单个患者在心源性休克的管理决策；(2)老年心源性休克治疗强调跨学科团队的综合评估、医患共同决策。因此，本文就老年心源性休克相关急诊急救最新实践以及CS“休克中心”建设做一解读，希望能够进一步提升对心源性休克患者的多学科整合精准管理。更多还原

【Abstract】 Cardiogenic shock can be defined as a state of inadequate organ perfusion linked primarily to cardiac pump dysfunction. The two predominant causes of this condition are acute myocardial infarction and acutely decompensated heart failure(ADHF). In recent years,with the acceleration of population aging,a significant increase in cases of cardiogenic shock from ADHF has been described in the elderly. Mechanical circulatory support,such as veno-arterial extracorporeal membrane oxygenation(V-A ECMO)is increasingly used in patients with cardiogenic shock despite the lack of evidence from adequately powered randomised clinical trials. However,elderly patients presenting with cardigenic shock represent a challenging patient population for heart transplantation and durable left ventricular assist devices. On February 26th,the American Heart Association(AHA)published a scientific statement in Circulation. In this American Heart Association scientific statement,itproposed:(1)age as a lone parameter should not be used to guideindividual patient management decisions in cardiogenic shock;(2)In the assessment of risk in older adults with cardiogenic shock,a comprehensive,interdisciplinary approach,and doctor-patientshared decision-ma King is central to developing best practices.Based on this statement,the latest emergency practice related tocardiogenic shock in the elderly and“shock center”with a highvoice were discussed in this review,aiming to improve the pre-cise management of old adults with cardiogenic shock.更多还原