AMI再灌注治疗策略__培训课件.ppt

* * * Routine Measures Nitroglycerin Class I . Patients with ongoing ischemic discomfort should receive sublingual nitroglycerin (0.4 mg) every 5 minutes for a total of 3 doses, after which an assessment should be made about the need for intravenous nitroglycerin. (Level of Evidence: C) 2. Intravenous nitroglycerin is indicated for relief of ongoing ischemic discomfort, control of hypertension, or management of pulmonary congestion. (Level of Evidence: C) Class III 1. Nitrates should not be administered to patients with systolic blood pressure less than 90 mm Hg or greater than or equal to 30 mm Hg below baseline, severe bradycardia (less than 50 bpm), tachycardia (more than 100 bpm), or suspected RV infarction. (Level of Evidence: C) 2. Nitrates should not be administered to patients who have received a phosphodiesterase inhibitor for erectile dysfunction within the last 24 hours (48 hours for tadalafil). (Level of Evidence: B) Antman et al. JACC 2004;44:679. Routine Measures Aspirin Class I 1. Aspirin should be chewed by patients who have not taken aspirin before presentation with STEMI. The initial dose should be 162mg (Level of Evidence: A) to 325 mg (Level of Evidence: C). Although some trials of have used enteric-coated aspirin for initial dosing, more rapid buccal absorption occurs with non-enteric-coated aspirin formulations. Antman et al. JACC 2004;44:680. Routine Measures ?-blocking agents Class I 1. Oral beta-blocker therapy should be administered promptly to those patients without a contraindication, irrespective of concomitant fibrinolytic therapy or performance of primary PCI. (Level of Evidence: A) Class IIa 1. It is reasonable to administer IV beta-blockers promptly to STEMI patients without contraindications, especially if a tachyarrhythmia or hypertension is present. (Level of Evidence: B) Antman et al. JACC 2004;44:680. Inhibition of Renin-Angiotensin-Aldosterone System Class I 1. An angiotensin converting enzyme (ACE) inhi