急性心肌梗死溶栓治疗进展张福春.pptVIP

溶栓治疗后：立即介入？缺血导向介入 大出血 Heart 2010；96：1695 第六十页，共六十三页，2022年，8月28日 溶栓治疗后：立即介入？缺血导向介入 Eur Heart J 2010 31，2156 长期预后 第六十一页，共六十三页，2022年，8月28日 症状的识别 医疗救助的呼叫 急诊室 导管室 院前 再灌注治疗开始的延迟 CCU 心肌丢失的增加 再灌注治疗开始的时间 Modified from Armstrong,Collen Antman Circ 2003 第六十二页，共六十三页，2022年，8月28日 采取有创性治疗？ 问：你能保证介入治疗使你的病人有效且安全吗？？？ 答：是的-介入治疗 答：不肯定-溶栓治疗 第六十三页，共六十三页，2022年，8月28日 * * 再灌注治疗即通过开通闭塞的血管恢复血流供应 * * 早期静脉溶栓治疗能提高STEAMI病人的生存率 GISSI-1的10年随访结果反映，ST段上抬的AMI病人，滴注链激酶一小时，在随后的10年间心肌梗死死亡危险从治疗1000例中的469例减至450例。即每治疗1000例可以减少19例死亡。一小时内就医的病人，益处陡增（每治疗1000例，减少死亡80例）。 * * 无论采用哪种再灌注方法，时间对再灌注治疗非常重要 在一系列溶栓研究中发现，尽早溶栓治疗可以显著降低STEMI病死率 * Intracranial haemorrhage and mortality of available thrombolytic agents A comparison of intracranial haemorrhage and mortality rates reported in the major thrombolytic trials shows that tenecteplase is associated with an incidence of intracranial haemorrhage that is within the range reported within all major thrombolytic trials. * 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. Circulat