STEMI急诊救治新理念：无条件转运.pptVIP

Adjunctive Antithrombotic Therapy to Support Reperfusion With Fibrinolytic Therapy (2013ACCF/AHA) Anticoagulant therapy Class Level Fondaparinux: Initial dose 2.5mg IV, then 2.5mg subcutaneouly daily starting the following day, for the index hospitalization up to 8 d or until revascularization I B Contraindicated if CrCl30ml/min Indications for Transfer for Angiography After Fibrinolytic Therapy (2013ACCF/AHA) Recommendation Class Level Immediate transfer for cardiogenic shock or severe acute HF irrespective of time delay from MI onset I B Urgent transfer for failed reperfusion or re-occlusion IIa B As part of an invasive strategy in stable patients with PCI between 3 and 24 h after successful fibrinolysis IIa B Recommendation Class Level 也可请有资质的医生到有PCI硬件设备，但不能独立进行PCI的医院，进行直接PCI。 IIb C 不具备PCI条件且不能在90 min内完成转运的医院，应立刻进行溶栓治疗。 I A 对怀疑心肌梗死的患者，不管是否接受直接PCI，建议院前使用抗栓治疗，包括强化抗血小板药物(水溶性阿司匹林150～300 mg，氯吡格雷300mg)和抗凝药物(普通肝素或低分子肝素) I C 急性ST段抬高型心肌梗死诊断和治疗指南2010 CHINA Transfer For Cardiogenic Shock The SHOCK trial demonstrated benefit with coronary angiography and emergency revascularization compared with immediate medical stabilization and delayed revascularization in patients with ST-elevation/Q-wave or new LBBB MI and cardiogenic shock. For patients with cardiogenic shock, the benefit of emergency revascularization was apparent across a very wide time widow, extending up to 54 hours after MI and 18 hours after shock onset. Two RCTs have report improve rates of neurologically intact survival to hospital discharge when comatose patients with out-of-hospital VF or non-perfusing VT cardiac arrest were cooled to 32 ℃ to 34 ℃ for 12 or 24 hours beginning minutes to hours after the return of spontaneous circulation. Sudden Cardiac Death and STEMI Therapeutic hypothermia should be started as soon as possible in comatose patients with STEMI and out-of-hospital cardiac arrest caused by ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), inc