急性心肌梗塞并发症的康复疗法临床研究

急性心肌梗塞(AMI)是最危重的急症之一,而急性心肌梗塞的并发症又是灾难性的危急症,严重威胁着患的生命,因此正确的防治,科学地康复疗法以降低死亡率,提高康复率,是临床研究的非常重要的课题。章就急性心肌梗塞的并发症类型;急性心肌梗塞的治疗原则等问题进行了较为详细的阐述。并就急性心肌梗塞的康复疗法：包括急性期与恢复期和复原一维持期的具体康复疗法进行了论述。对心肌梗塞康复过程中的功能监测、心电图监测、运动试验、血液动力学监测、超声心动图监测、动态心电图监护、放射核素扫描等提出了自己的见解．同时把心肌梗塞的心理康复也列为心肌梗塞并发症的康复医疗的重要措施。     

急性心肌梗塞病人的心理障碍与康复疗法的研究

通过临床研究的结果来看,对急性心肌梗塞病人的心理障碍实施心理康复疗法不仅可使心肌梗塞的患者心理状态有明显改善,对心肌梗塞的整体治疗效果有着十分重要的作用。因此在急性心肌梗塞的患者中进行心理康复是非常重要的不可缺少的医疗措施。文章重点就焦虑的发生与康复疗法;否认的产生与康复疗法;抑郁的出现与康复疗法;病态性格及行为与康复疗法;谵妄的发病因素与康复疗法;睡眠周期紊乱与康复疗法等问题进行了详细的论述     

急性心肌梗塞病人的心理障碍与康复疗法的研究

通过临床研究的结果来看．对急性心肌梗塞病人的心理障碍实施心理康复疗法不仅可使心肌梗塞的患心理状态有明显改善,对心肌梗塞的整体治疗效果有着十分重要的作用。因此在急性心肌梗塞的患中进行心理康复是非常重要的不可缺少的医疗措施。章重点就焦虑的发生与康复疗法;否认的产生与康复疗法;抑郁的出现与康复疗法;病态性格及行为与康复疗法;谵妄的发病因素与康复疗法;睡眠周期紊乱与康复疗法等问题进行了详细的论述。     

基层医院急性心肌梗塞的临床治疗体会

急性心肌梗塞是心内科急症、重症，根据心肌缺血心电图上ST段是否抬高可将急性心肌梗塞分为ST段抬高性心梗（STEMI，也称透壁性心肌梗塞）和非ST段抬高性心梗（NSTEMI）。临床上对STEMI需要对心肌进行针角灌注治疗。溶栓疗法是基层医院对急性心肌梗塞进针角灌注治疗的主要方法。     

老年急性心肌梗塞的康复护理

急性心肌梗塞是老年人常见的心脏急症，常发生急性左心衰、心源性休克、心律失常、猝死等严重并发症。要降低老年急性心肌梗塞的病死率，减少并发症，必须采取有效的治疗方法和切实可行的康复护理措施。1988年以来，我们共收治老年急性心肌梗塞患86例，其中46例患有不同程度合并症。本仅就并发症的护理以及无并发症患的康复计划报告如下。     

急性心肌梗塞治疗和护理的新进展

急性心肌梗塞是一种常见急症，对急性心肌梗塞病人进行正确及时的治疗和护理是十分必要的。本文就急性心肌梗塞病人治疗方面的新进展及对急性心肌梗塞病人的疼痛护理、溶栓护理、康复护理等方面的新进展作一综述。     

有关心肌梗塞的若干问题

急性心肌梗塞(AMI)是内科最常见急症之一,能否及时作出早期诊断和采取有效的治疗措施,直接关系到患者的安危。一般而言,典型的心肌梗塞诊断并不困难,但是不典型的心肌梗塞(包括临床表现、心电图和血清酶学等不典型者)诊断并非易事。因此,在临证时必需随时提高警惕,慎密观察病情变化和做好心电图、酶学的复查工作至关重要,对可疑病例有时不能凭1～2次心电图或酶学结果作出否定诊     

急性心肌梗塞早期康复体会

近年来我国心肌梗塞的发病率逐年升高，急性心肌梗塞的康复治疗，已成为临床常见课题之一。对无并发症的急性心肌梗塞患者进行早期康复治疗，有利于患者早日恢复健康。在康复中，如何严密观察病情变化，是十分重要的一环。现将我们３年来资料较完整的２５例治疗体会介绍如...     

26例早期心肌梗塞的心电图分析

急性心肌梗塞为内科常见急症之一。其心电图诊断一般是依靠出现病理性Q波、ST段抬高及T波改变。Schamroth根据心肌梗塞的电病理学改变将其分为三个重要时期：超急性损伤期一早期、充分进展期和慢眭稳定期。早期的心电图改变包括：斜升ST段（即J点上移）、巨大高耸的T波和R波而无Q波。据此标准，现将本院近年来收治的26例早期心肌梗塞的心电图变化分析报道如下。     

1565例急性心肌梗塞定位诊断分析

急性心肌梗塞是冠状动脉闭塞血流中断,导致心肌严重而持久缺血所引起的心肌坏死,急性心肌梗塞为临床急症,死亡高,猝死是其死亡的重要原因之—、根据心脏冠状动脉分布特点分别出现不同部位的心肌梗塞,本文主要分析比较了下壁心肌梗塞的发病率及其易患因素。     

高浓度极化液联合曲美他嗪对急性心肌梗死面积及心功能的影响

目的：评价高浓度极化液（GIK）联合曲美他嗪经代谢途径治疗对急性心肌梗死（AMI）患者梗死面积及心功能的影响。方法：将46例急性前壁心肌梗死患者随机分为代谢药物治疗组（n=25）和对照组（n=21）,记录每例患者入院即刻和第1、3、7、14天12导联心电图。用Wagner的QRS记分预测梗死面积。于治疗14d后行核素心血池心室造影,判断心功能。结果：经代谢途径治疗后第7、14天,QRS记分较对照组显著降低,梗死面积的扩大、保护缺血心肌的损伤及改善心功能均有显著疗效。     

急性心肌梗塞并发心脏破裂的救治及心电监护指导

心脏破裂是急性心肌梗塞（ＡＭＩ）的致命性并发症,及时准确的诊断、抢救措施对其的救治率有着重要的决定作用,是心血管内、外科临床医师研究的重要课题。科学的心电监测是准确及时诊断的关键性手段,是判断病情演变和预后必不可少的措施,指导治疗及治疗措施的调整更显出它的重要地位。文章重点就室间隔穿孔的诊断与处理;心脏游离壁破裂的诊断与处理;室壁瘤的诊断与处理;乳头肌断裂的诊断与处理及ＡＭＩ并发心脏破裂的心电监测与康复疗法等问题进行论述     

Body surface mapping improves diagnosis of acute myocardial infarction in the emergency department

Traditionally, the diagnosis of acute myocardial infarction (AMI) in emergency departments is done through an assessment of history and presenting symptoms, 12-lead electrocardiogram (ECG), and cardiac biomarkers. The 12-lead ECG is not highly sensitive for detecting ECG changes, and some infarctions may be missed. Failure to identify patients in the early stages of AMI can result in failure to provide beneficial therapies. New technology, the 80-lead ECG, uses body surface mapping to provide a more comprehensive view of cardiac electrical activity. Body surface mapping has greater sensitivity in detecting AMI in the inferoposterior portions of the left ventricle and the right ventricle. Portable hardware and user-friendly software coupled with an easily applied disposable torso vest containing the electrodes produce a 12-lead ECG, 80-lead ECG, and color contour torso or flat map showing ECG changes. Recent studies support the use of 80-lead body surface mapping for detecting AMI in the emergency department.     

冠状动脉溶栓治疗急性心肌梗塞的临床观察

通过对急性心肌梗塞（ＡＭＩ）早期（自胸痛到冠脉溶栓开始＜１２小时）患者１５例（治疗组，其中男性１３例，女性２例，平均年龄５４．１３±５．９４岁，前壁梗塞７例，下壁梗塞７例，高侧壁梗塞１例）行冠状动脉内溶栓治疗（治疗组），并与１６例非溶栓治疗患者（对照组，其中男性１２例，女性４例，平均年龄为６２．１８±６．３５岁，前壁梗塞１１例，下壁梗塞５例）比较。结果：治疗组在发病后两周ＵＣＧ示左房内径为３４．７４±３．６３ｍｍ，左室内径５１．２０±４．９１ｍｍ，左室射血分数（ＥＦ）为０．６３±０．１１，明显优于对照组的左房内径３９．９３±３．２１ｍｍ，左室内径５６．４４±５．４７ｍｍ，ＥＦ０．５２±０．１５；运动试验：治疗组１５例中阳性７例，对照组１６例中阳性１１例；经冠脉成形术后运动试验均阴性。从而说明急性心肌梗塞冠脉再通治疗是防止梗塞后心脏几何形状变形（即心室结构重建），从而保存心脏整体与节段的功能，提高梗塞后远期存活率的重要治疗手段。     

Using the 12-lead ECG to diagnose acute myocardial infarction in the presence of left bundle branch block

The 12-lead ECG is a powerful clinical tool used to risk stratify patients presenting to the emergency department with chest pain. In particular the ECG is used as the diagnostic tool to instigate reperfusion therapy in patients with acute coronary syndromes. The ECG features of acute myocardial infarction (AMI) may be masked by the presence of left bundle branch block (LBBB) and the ECG may be difficult to interpret. Invariably this results in delays to the provision of thrombolysis to these patients despite the mounting body of evidence which demonstrates that patients with AMI who present with LBBB have greater in-hospital mortality than those who do not. Difficulties in interpreting the ECG in these patients can therefore delay treatment and compromise their prognosis. The utility of the ECG for the diagnosis of AMI in the presence of LBBB has recently received renewed attention. ECG criteria have been identified which have a high association with AMI in patients with LBBB and two ECG tools have been evaluated in clinical practice which utilise these ECG criteria. The use of these simple algorithmic tools is recommended for clinical practice.     

Thrombolytic therapy and cocaine-associated acute myocardial infarction

The role of thrombolytic therapy in patients with cocaine-associated acute myocardial infarction (AMI) is controversial. Some have suggested that because the AMI mortality may be low in young patients with cocaine usage, the risks outweigh the benefits of thrombolytic therapy. Two cases of cocaine-associated AMI are presented. Each case illustrates different aspects of this controversy. In one case, ECG interpretation and concerns with thrombolytic therapy in this setting led to prolonged treatment delay. The second case illustrates unrecognized cocaine-associated AMI treated safely with thrombolytic therapy and beta-blockade. The arguments for and against thrombolytic therapy in this setting are discussed. The available literature suggesting increased risk associated with thrombolytic therapy in patients with cocaine-associated AMI is critically reviewed.     

Instability of ST segments in the early stages of acute myocardial infarction in patients undergoing continuous 12-lead ECG monitoring

Many patients presenting to the emergency department with suspected acute myocardial infarction (AMI) have an initial 12-lead electrocardiogram (ECG) nondiagnostic for acute injury and thus do not meet any accepted ECG criteria for thrombolytic therapy. Early studies in the use of intracoronary thrombolytic therapy documented that cyclic variations in ST segment magnitudes between normalcy and injury are common during the early phase of AMI and correspond to spontaneous intermittent coronary opening and reocclusion. The reliance on a single ECG to diagnose AMI may mean that many patients with AMI are missed if the initial ECG is obtained during a window of ST segment normalcy. We present 3 patients with AMI who underwent continuous 12-lead ST segment monitoring with frequent serial ECGs whose ST segments periodically normalized during the acute injury phase. We believe continuous 12-lead ST segment monitoring with frequent serial ECGs can aid the physician in identifying patients with AMI who may benefit from thrombolytic therapy and other urgent revascularization techniques.     

Prehospital recognition of AMI using independent nurse/paramedic 12-lead ECG evaluation: Impact on in-hospital times to thrombolysis in a rural community hospital

Because the benefits from thrombolytic therapy in acute myocardial infarction (AMI) are time dependent, multiple strategies have been devised to speed therapy. This study sought to determine whether hospital-based nurse and paramedic advanced life support (ALS) providers could be trained to independently evaluate (sight read) a prehospital 12-lead electrocardiogram (ECG) for the presence of AMI as part of a protocol designed to speed in-hospital administration of thrombolytic agents. Providers were required to determine on the basis of a protocol (1) whether or not AMI was present, and (2) whether or not thrombolytic therapy was indicated. Providers then radioed their impression to the emergency department (ED) and initiated a protocol to prepare identified candidates for thrombolysis. The final decision to initiate thrombolytic therapy was made by the ED physician after patient arrival at the hospital. One hundred fifty-five patients with chest pain were studied. Twenty-one (13.5%) were ultimately proven in-hospital to have AMI. Providers were able to recognize AMI in 17 of 21. Four of 21 did not meet ECG criteria for AMI on the field ECG, but were categorized as having a high index of suspicion for AMI by providers. There were no false-positive diagnoses. Fourteen patients (9%) received thrombolytic therapy. In-hospital times to administration of thrombolytic therapy decreased to an average of 22 ± 13.8 minutes in the studied group compared with a historical control group average of 51 ± 50 minutes. It is concluded that hospital-based paramedics and nurses can successfully be taught to evaluate (ie, sight read) a prehospital ECG for the presence of AMI with accuracy. A prehospital chest pain protocol using a field ECG can speed in-hospital administration of thrombolytic therapy to the extent that field administration of thrombolytic agents may not significantly improve times to administration of therapy when transport times are similar to those of this study.     

The prehospital 12-lead electrocardiogram: impact on management of the out-of-hospital acute coronary syndrome patient

The electrocardiogram (ECG), when applied in the prehospital setting, has a significant effect on the patient with chest pain. The potential effect on the patient includes both diagnostic and therapeutic issues, including the diagnosis of acute myocardial infarction (AMI) and the indication for thrombolysis. The prehospital ECG may also detect an ischemic change that has resolved with treatment delivered by emergency medical services (EMS) prior to the patient's arrival in the emergency department (ED). Perhaps the most significant issue in the management of chest-pain patients involves the effect of the out-of-hospital ECG on the ED-based delivery of reperfusion therapy, such as thrombolysis. In AMI patients with ST-segment elevations, it has been conclusively demonstrated that information obtained from the prehospital ECG reduces the time to hospital-based reperfusion treatment. Importantly, these benefits are encountered with little increase in EMS resource use or on-scene time.     

ECG与心肌肌钙蛋白T在AMI诊断中的价值比较

目的　探讨心电图 (ECG)和心肌肌钙蛋白T(cTNT)在急性心肌梗死 (AMI)诊断中的价值。方法　选择 10 8例胸痛发作 3h内入院的AMI患者 ,并经ECG和cTNT双重连续性监测 ,对比AMI患者ECG特征性改变和相应时间里cTNT的变化。结果　 3h内ECG巨大高耸T占 5 6 %、cTNT升高超出正常者 5 4 % ,2 4hECG出现病理性Q波 78%、cT NT明显升高者 10 0 % ,72h心电图ST段稳定下降者 6 5 %、cTNT均保持较高水平的升高。结论　cTNT对AMI的特异性、敏感性优于ECG ,且诊断时间窗宽 ,但对确立梗死的部位和显示梗死是否穿壁不如ECG