心血管
词汇介绍
拓展阅读
解析
elevation 英 /,elɪ'veɪʃ(ə)n/ 美 /,ɛlɪ'veʃən/
释 义 抬高,海拔,标高,高度
例 句 Objective: To observe the clinical effect and safety in treatment of non-ST elevation myocardial infarction (NSTEMI) with clopidogrel. 目的 观察氯吡格雷治疗急性非ST段抬高心肌梗死(NSTEMI)的临床疗效及安全性。
myocardial 英 /,maɪəʊ'kɑːdɪəl/ 美 /,maɪə'kɑrdɪəl/
释 义 adj. 心肌的;n. 心肌衰弱
同根词 myocardium n. 心肌;心肌层
例 句 Stem cells transplantation bring new hope of treatment for myocardial infarction.
干细胞移植为心肌梗死的治疗带来了新的希望。
Infarction 英 /ɪn'fɑːkʃ(ə)n/ 美 /ɪn'fɑrkʃən/
释 义 n. 梗塞;[病理] 梗塞形成,梗死形成
同根词 infarct n. 梗死;梗塞
例 句 Objective To evaluate the influence of amiodarone upon arrhythmia sudden death patients after myocardial infarction.
目的 评价胺碘酮对心肌梗塞后患者心律失常猝死的预防作用。
概述
定义
急性冠脉综合征(acute coronary syndrome, ACS)有3种类型:ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)、非ST段抬高型心肌梗死(non-ST elevation myocardial infarction, NSTEMI)和不稳定型心绞痛(unstable angina, UA)。其中,STEMI是指有持续胸部不适或提示缺血症状,持续超过20分钟,并且ECG至少两个相邻导联ST段抬高的一类急性心肌梗死。
心电图表现
急性STEMI患者的ECG按特定顺序发生演变。STEMI最早的ECG改变是出现超急性期或高耸T波,提示局部高钾血,但并不常见。此后,记录受累心肌区域电活动的导联上出现ST段抬高;ST段波形如下:最初,J点抬高,ST段保持凹形。一段时间后,ST段抬高更加明显,且更凸起或弓背向上。ST段最终可能与T波无法区分;QRS-T波群可能类似于单相动作电位。ESC/ACCF/AHA/WHF的心肌梗死定义联合委员会制定了STEMI诊断的具体ECG标准:两个解剖学相邻导联新发J点ST段抬高,诊断临界标准:除V2-V3导联外的其他所有导联J点ST段抬高≥0.1mV。V2-V3导联采用如下标准:≥40岁的男性中,抬高≥2 mm;<40岁的男性中,抬高≥2.5 mm;任何年龄段的女性,抬高≥1.5 mm。
临床表现
最主要表现为胸痛。常位于胸骨后或左胸部,可有放射痛,胸痛持续时间大于10-20分钟,呈剧烈的压榨性疼痛或压迫感、烧灼感,常伴有恶心、呕吐、大汗和呼吸困难等,含硝酸甘油不能完全缓解。
治疗
所有ST段抬高型心肌梗死(STEMI)的患者都应该进行抗凝治疗,并且应该在诊断后尽快抗凝。抗凝药的选择取决于每例患者的治疗策略。对于STEMI患者,无论采用何种治疗策略[溶栓、直接经皮冠状动脉介入治疗(PCI)或药物治疗],有力的证据支持早期给予双联抗血小板治疗(DAPT)(阿司匹林+血小板P2Y12受体阻滞剂)。对计划行直接PCI患者,静脉内给予GPⅡb/Ⅲa受体抑制剂的治疗作用有限;而对行纤溶治疗或不进行再灌注治疗的患者,静脉给予GPⅡb/Ⅲa受体抑制剂没有作用。
给药方法
一旦确诊后,尽快给予负荷量(loading dose, LD)的无包衣阿司匹林,可在救护车上或急诊科给予。一旦选定了再灌注治疗策略,包括经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)、纤溶治疗或非再灌注治疗,对所有患者均给予P2Y12受体阻滞剂。对于行直接PCI患者,优选替格瑞洛或普拉格雷。对于行纤溶治疗患者,优选氯吡格雷;而对于不进行再灌注治疗患者,优选替格瑞洛。但这种给药方法有一种少见的例外情况,即预期行早期冠状动脉旁路移植(coronary artery bypass graft, CABG)患者,仅给予阿司匹林而不联用P2Y12受体阻滞剂。对于大多数STEMI患者,不给予糖蛋白(glycoprotein, GP)Ⅱb/Ⅲa受体抑制剂。在心导管室发生无复流、慢复流、巨大血栓的证据,或临床上考虑患者病情不稳定与缺血加重有关时,可以使用这种药物。
Acute Myocardial Infarction复制标题
急性心肌梗死
发表时间:2019-04-11
影响指数:79.3
作者: Jeffrey L. Anderson
期刊:N. Engl. J. Med
Acute myocardial infarction with or without ST-segment elevation (STEMI or non-STEMI) is a common cardiac emergency, with the potential for substantial morbidity and mortality. The management of acute myocardial infarction has improved dramatically over the past three decades and continues to evolve. Emergency reperfusion of ischemic myocardium that is in the process of becoming infarcted is the most important advance in the treatment of STEMI over the past three decades and is the primary therapeutic goal. Coronary reperfusion is accomplished by means of primary PCI (angioplasty and stenting) or intravenous fibrinolytic therapy. Prompt PCI (with a performance goal of ≤90 minutes from the first medical contact) is the preferred approach at PCI-capable hospitals for STEMI with onset of symptoms within the previous 12 hours (ACC–AHA class I recommendation, evidence level A) and for STEMI with cardiogenic shock, regardless of the timing (ACC–AHA class I recommendation, evidence level B). The advantages of primary PCI over fibrinolysis include lower rates of early death, reinfarction, and intracranial hemorrhage. However, when PCI is delayed by more than 120 minutes, fibrinolytic therapy should be given if it is not contraindicated (ACC–AHA class I recommendation, evidence level A), followed by routine consideration of transfer in the following 3 to 24 hours to a PCI-capable facility (ACC–AHA class IIa recommendation, evidence level B). With broad application of reperfusion therapy for STEMI, 30-day mortality rates have progressively declined from more than 20% to less than 5%.
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