急性心肌梗死的溶栓治疗医学.pptVIP

* 药物+介入策略（Pharmacoinvasive） 大量研究事实与临床实践证实，单纯心血管介入或药物治疗无论多完美，但临床获益有限。 因此，将药物治疗与介入干预合二为一的药物介入干预策略将是未来冠心病救治的大方向，这也是近年来欧美相关指南所传递的重要精髓。 溶栓后早期PCI治疗STEMI正在进行探索性研究。 * * 众多研究认为三支病变与左主干(LM)病变的ST段压低主要在I、II、aVL、V3~V6 导联，ST段抬高主要在aVR、V1、I导联; 伴aVR导联ST段抬高的心肌梗死(MI)患者心脏事件显著多于aVR导联ST段无抬高的患者，说明aVR导联ST段抬高是LM病变或严重的多支病变的重要预测因子， * MI: Defined 2000 新近的坏死生化标志物明显升高并且逐渐下降（肌钙蛋白），或迅速上升与回落（CK-MB）， MI: Defined 2007 心脏标志物（最好为肌钙蛋白Troponin）出现至少一次异常的升高或降低， * * Goals for AMI Therapy The primary goal of therapy for AMI is to reduce the likelihood of mortality in the post-infarction period. The second and equally important goal is to leave the AMI survivor with an improved outcome.1 Since large infarcts lead to deteriorating pump function and secondary arrhythmias, effective treatments for AMI strive to preserve left ventricular (LV) function , resolve ST-segment elevation, and rapidly restore coronary blood flow to ischemic myocardium.1,2,3 Very early initiation of thrombolytic therapy, within 70 to 90 minutes after the onset of AMI symptoms is associated with improved survival rates and better LV function.3 Complete and sustained thrombolysis with TIMI 3 coronary perfusion is also critical for optimal outcomes,3 as well as for preventing late reocclusion. A key strategy to achieving all these goals is to shorten the time to perfusion. 1. Yusuf S, Sleight P, Held P, et al. Routine medical management of acute myocardial infarction: lessons from overviews of recent randomized controlled trials. Circulation. 1990;82 (suppl II):II-117-II-134. 2. Schr?der R, Wegscheider K, Schr?der K, et al. Extent of early ST segment elevation resolution: a strong predictor of outcome in patients with acute myocardial infarction and a sensitive measure to compare thrombolytic regimens. A substudy of the International Joint Efficacy Comparison of Thrombolytics (INJECT) Trial. J Am Coll Cardiol. 1995;26:1657-1664. 3. Smalling RW, Bode C, Kalbfleisch J, et al. More rapid, complete, and stable coronary thrombolysis