急性冠脉综合征诊治质量控制标准急性心肌梗死诊治疗解读_培训课件.pptVIP

* 突发冠状动脉梗塞后的心肌坏死与血管梗塞时间关系曲线分为几个阶段：起始阶段平坦，该阶段几乎没有心肌坏死，时间持续大约是冠状动脉梗塞后20分钟；第2阶段斜率明显升高，心肌坏死量明显增加，如果在这段时间内争取抢时间，尽管只缩短一部分时间，但是可以抢救大量的心肌；第3阶段平坦，时间延迟对心肌坏死量的变化不大。溶栓药物治疗的目的就是降低第2阶段曲线的斜率，以保护心肌。 * 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