课件：非段抬高型急性冠脉综合征的诊疗质量控制标准解读.ppt

* 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 with bolus administration of reteplase compared with alteplase infusion in acute myocardial infarction. Circulation. 1995;91:2725-2732. * * 经典的ISIS-2研究显示溶栓治疗确实起作用。链激酶(SK)溶栓药物与ASS联合治疗后的死亡率相对于对照组ASS明显降低。 * GISSI试验显示了再灌注时间与降低的死亡率之间的关系，y轴为降低的死亡率，x轴为再灌注时间。1小时内开始溶栓治疗，降低死亡率47％；3小时内治疗，降低死亡率23％，疗效降低一半；3至6小时内治疗，降低死亡率17％；6至9小时治疗，溶栓治疗几乎没有疗效。 intracranial 体外膜肺氧合 * Greatest emphasis is to be placed on the delivery of reperfusion therapy