共查询到19条相似文献,搜索用时 91 毫秒
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基层医院急性心肌梗死498例药物应用分析 总被引:3,自引:0,他引:3
近年来,大量临床实验已经证实早期再灌注治疗和早期使用β受体阻滞剂(BB)、血管紧张素转换酶抑制剂(ACEI)可提高急性心肌梗死(AMI)患者的存活率,我国2001年制定的AMI诊疗指南强调了这些治疗的必要性[1]. 相似文献
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临床和病理解剖资料证实冠状动脉内血栓形成是急性心肌梗死(AMI)发生的最主要原因,因此,溶栓治疗是目前AMI早期治疗的最有效措施之一。我们近年用尿激酶静脉溶栓治疗AMI取得了较好的临床疗效,现报道如下。 相似文献
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冠状动脉造影评价急性心肌梗死溶栓疗法的疗效 总被引:2,自引:0,他引:2
目的:冠状动脉造影(CAG)评价静脉溶栓治疗急性心肌梗死(AMI)的疗效及安全性。方法:110例AMI患者应用国产尿激酶及进口链激酶开始溶栓治疗后90分钟行CAG。结果:尿激酶和链激酶血管开通率分别为60.8%及63.0%;CAG提示有残留血栓的分别为86.9%及81.5%;5周病死率分别为8.6%及7.4%;严重出血并发症分别为1.85%及2.17%,均无统计学意义。加大尿激酶剂量至200IU,并不增加血管开通率反而增加出血并发症。结论:AMI是由突然冠状动脉血栓性闭塞所致。尿激酶和链激酶用于静脉溶栓治疗可使闭塞的冠状动脉再通,两种溶栓剂疗效相似 相似文献
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慢性心力衰竭治疗药物的循证医学评价 总被引:1,自引:0,他引:1
近20年来,慢性心力衰竭的治疗已经从短期血流动力学或药理学措施转为长期修复性策略。现根据大量临床试验结果对治疗慢性心力衰竭的药物从疗效、不良反应等进行了比较,发现在利尿剂治疗基础上加用血管紧张素转换酶抑制剂、β受体阻滞剂、醛固酮受体拮抗剂和血管紧张素受体拮抗剂等能改善心力衰竭患者预后,而正性肌力药物等对预后无益。因此,在临床上积极使用有循证医学证据的治疗慢性心力衰竭的药物将会给患者预后带来益处。 相似文献
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循证护理在急性心肌梗死早期溶栓并发症中的应用 总被引:1,自引:0,他引:1
循证护理(EBN)是在循证实践(EBP)影响下产生的一种指导临床护理的观念和工作方法。我们根据急性心肌梗死(AMI)早期溶栓治疗常发生再灌注心律失常(RA)、 相似文献
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老年急性心肌梗死尿激酶静脉溶栓疗效观察 总被引:1,自引:0,他引:1
目的探讨老年急性心肌梗死尿激酶静脉溶栓的疗效。方法对我院心内科2001年1月~2005年9月收治的60岁以上急性心肌梗死行尿激酶静脉溶栓治疗的16例患者进行了回顾性分析,观察急性心肌梗死后12h内不同时间溶栓治疗后冠脉再通率、4周病死率及溶栓治疗的并发症。结果尿激酶静脉溶栓治疗老年急性心肌梗死患者16例,冠脉再通7例,再通率43.8%。急性心肌梗死4h内溶栓再通率最高,差异有显著性。老年急性心肌梗死尿激酶静脉栓治疗出血并发症轻微,无中重度出血并发症。结论老年急性心肌梗死尿激酶静脉溶栓治疗可降低4周病死率,溶栓距发病4h内血管再通效果最好。溶栓出血并发症轻微,针对老年急性心肌梗死患者,早期尿激酶静脉溶栓安全、有效。 相似文献
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吴长威 《中华现代内科学杂志》2006,3(5):532-533
目的研究急性心肌梗死(AMI)溶栓治疗的近期临床疗效。方法320例AMI患者中240例进行溶栓治疗,80例未溶栓治疗。分为再通组、未通组、未溶栓组,比较组间近期临床预后的差异。结果再通组近期临床预后明显好于未通组,而未通组与未溶栓组比较,临床预后略好,但差异无显著性。结论溶栓治疗是AMI的首选治疗方法。 相似文献
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SVEIN GOLF PIERRE VOGT URS KAUFMANN ULRICH SIGWART LUKAS KAPPENBERGER 《Journal of internal medicine》1988,224(6):523-529
Abstract. Intravenous thrombolytic treatment (streptokinase or anisoylated plasminogen streptokinase activator complex (APSAC) was given to 50 consecutive patients within 3 hours after onset of symptoms of acute myocardial infarction. Left heart catheterisation with coronary angiography and simultaneous double view left ventriculography were performed approximately 4 hours after start of thrombolytic treatment. This examination showed that the acute infarct-related coronary artery was open in 36 patients (72%) and closed in 14 patients (28%). A higher left ventricular ejection fraction was found among patients with open, than among patients with closed infarct-related artery (58.8% vs. 48.4%, p=0.05). The group with open artery also had a lower score of regional left ventricular dysfunction (1.7 vs. 2.4, p<0.05, on a scale from 0–3). Single, double and triple vessel coronary heart disease was found in 22, 14 and 13 patients respectively. Mean age was lower in the group with single vessel disease as compared to double and triple vessel disease (48.4 years vs. 53.4 and 55.4 years, p<0.05 and p<0.005). Independently of whether the infarct-related artery was open or closed, there tended to be an inverse correlation between number of diseased vessels and preservation of left ventricular function (statistical significance only for single vessel versus triple vessel disease with respect to score of regional left ventricular dysfunction, 1.8 vs. 2.4, p<0.05). These findings suggest that early thrombolytic treatment within 3 hours of onset of symptoms may preserve myocardial tissue during the evolution of acute infarction. Furthermore, a presumably better collateralisation from adjacent coronary arteries without stenoses may be important for myocardial preservation. Finally, early angiographic examination can be performed safely and is a good support for determination of further treatment, which in the actual patients was coronary bypass surgery in 8 cases, transluminal angioplasty, PTCA, in 20 cases, and medical treatment alone in 22 cases. 相似文献
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目的评价中医药治疗急性心肌梗死的有效性和安全性。方法设计随机临床试验的系统评价。检索中医药治疗急性心肌梗死的随机临床试验。无论使用盲法与否或以何种语言发表均无限制。结果 56篇文章符合纳入标准,对其中17篇Jadad评分质量相对较高的文章进行系统评价,结果显示中医药可以减少急性心肌梗死患者溶栓并发症,降低患者死亡率,提高患者临床总体疗效。结论根据本系统评价,中医药治疗急性心肌梗死安全有效,不良反应轻微。 相似文献
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R. Andrew Archbold MD Kulasegarum Ranjadayalan M Phil Abdel Suliman MBBS Charles J. Knight MD Andrew Deaner MB ChB Adam D. Timmis MD 《Clinical cardiology》2010,33(3):E25-E29
Thrombolytic therapy reduces mortality in patients with acute myocardial infarction (AMI) and left bundle branch block (LBBB). The difficulty in accurately diagnosing AMI in patients with LBBB, however, might result in their undertreatment. Among 3,890 patients hospitalized with chest pain, 241 (6.2%) had LBBB at presentation. The only variable independently associated with AMI among patients with LBBB was in‐hospital left ventricular failure (odds ratio [OR]: 4.32, 95% confidence interval [CI]: 1.95–9.57, p < 0.0005). Only 16 (29%) of the LBBB patients with AMI received thrombolytic therapy compared with 583 (78%) of the 747 patients with ST‐elevation AMI (p < 0.0005). A further 19 (10%) LBBB patients without AMI also received thrombolysis. Difficulty in making an accurate early diagnosis in patients with LBBB ensures that the majority of those with AMI fail to receive thrombolytic therapy while others without AMI are treated inappropriately. Improved diagnostic and therapeutic strategies are needed for patients with acute coronary syndromes and LBBB. Copyright © 2010 Wiley Periodicals, Inc. 相似文献
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急性心肌梗死后心肌组织再灌注程度与左心室功能和临床预后密切相关,因此,及时、准确的评估心肌梗死后心肌组织灌注水平对患者有着重要的意义.现就评价心肌组织再灌注的方法及应用做一综述. 相似文献
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急性心肌梗死(AMI)相关动脉的血运重建,开创了AMI现代治疗的新纪元,减少了AMI患者住院并发症和死亡率,改善了预后,但AMI仍是冠心病主要的死亡原因,相关冠状动脉血运重建后一年内心血管病事件的发生率仍在18%左右。相关冠状动脉局部病变的介入治疗为目前成熟并普遍推广应用的技术,但对介入治疗后的心肌组织无复流现象,尽管近年来进行机械、药物干预的许多尝试,仍无理想的干预对策,原因在于AMI作为一种应激损伤引起的机体病变的复杂性,包括内皮功能障碍、高凝状态、氧化应激、微血栓形成等,使心肌组织无法得到理想灌注,心肌细胞不能恢复正常的代谢状态。传统中医药包括益气、活血、解毒等的单味或复方中药,可作用于AMI后应激损伤的多个病理环节,如抑制氧化应激损伤、抗血小板聚集、改善微循环和内皮细胞功能等。应用现代科学技术,从复杂成分和效应关系,复杂效应和患者预后关系等方面进行系统研究,对提高现代中医药防治AMI的疗效将有十分重要的意义。 相似文献
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目的探讨溶栓治疗对急性心肌梗死(AMI)患者血浆内皮素(ET-1)、超敏C反应蛋白(hs-CRP)、血栓素A2(TXA2)、一氧化氮(NO)水平的影响及其临床意义。方法病例组32例,采用尿激酶溶栓治疗,分别测出溶栓前后再通组和未通组ET-1、NO、hs-CRP、TXA2水平的动态变化。正常对照组测空腹ET-1、NO、hs-CRP、TXA2水平。结果病例组ET-1、hs-CRP、TXA2水平高于正常对照组(P<0.05),NO水平低于正常对照组(P<0.05);溶栓再通组的ET-1、NO、hs-CRP、TXA2水平显著增高,且峰值显著高于溶栓未通组的峰值(P<0.05);再通组ET-1、hs-CRP、TXA2和NO峰值提前,都在溶栓后3 h,而溶栓未通组峰值均为溶栓后5h。结论 ET-1、hs-CRP、TXA2和NO相互作用,参与了AMI的循环炎症反应和再灌注损伤,可作为判断AMI病情及溶栓治疗再通的可能指标。 相似文献
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Bolus Administration of Saruplase in Europe (BASE), a Pilot Study in Patients with Acute Myocardial Infarction 总被引:2,自引:0,他引:2
Bär FW Meyer J Boland J Betriu A Artmeyer B Charbonnier B Michels HR Tebbe U Spiecker M Vermeer F von Fisenne MJ Hopkins GR Barth H 《Journal of thrombosis and thrombolysis》1998,6(2):147-153
To study the safety and efficacy of the thrombolytic agent saruplase as a bolus, the angiographic and clinical outcomes of three bolus regimens were investigated in a pilot study conducted in 192 patients with an acute myocardial infarction and were compared with the standard regimen. Fifty-two patients received a double bolus of 40 mg and 40 mg after 30 minutes, 51 patients a bolus of 80 mg, and 36 patients a bolus of 60 mg. Fifty-three patients received the standard regimen (a bolus of 20 mg and 60 mg IV infusion over 1 hour). At 60 minutes TIMI 2 and 3 flow were, respectively, 9.6% and 61.5% with the 40/40-mg bolus, 15.7% and 51.0% with the 80-mg bolus, 16.7% and 30.6% with the 60-mg bolus, and 7.5% and 54.7% with the standard 20/60-mg infusion. At 90 minutes TIMI 2 and 3 flow improved to 9.6% and 73.1%, 15.7% and 56.9%, 13.9% and 36.1%, and 5.7% and 71.7%, respectively. The primary endpoint, persistent patency (TIMI 2 + 3) at 24–45 hours, was seen in 69.2%, 64.7%, 44.4%, and 67.9% of patients who had no rescue PTCA, respectively. Inclusion in the 60-mg bolus group was prematurely stopped because of their low patency rates. The 40/40-mg bolus group had the highest mortality rate (13.5%), whereas the 60-mg bolus group had no deaths. Other adverse event rates were similar in the four groups. This clinical outcome is highly influenced by rescue PTCA of patients with insufficient TIMI flow. This pilot study indicates that in patients with an acute myocardial infarction, a double bolus of 40/40 mg resulted in the highest patency but also had the highest complication rate. The 80-mg single bolus is an attractive alternative for further evaluation because of its acceptable patency and event profile, and its easy form of administration. 相似文献
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长期心肌缺血对急性心肌梗塞预后的影响 总被引:4,自引:0,他引:4
目的 :探讨长期心肌缺血对急性心肌梗塞 (AMI)临床表现与近期预后的影响。方法 : 回顾性分析了 5 96例心绞痛 (AP)病程≥ 2周的 AMI的临床资料 ,并与无 AP史或 AP<2周的患者比较。结果 : AP组合并休克、心衰者少于对照组 (分别为 10 .9%比 15 .8%和 19.8%比 2 5 .0 % ,均 P<0 .0 5 ) ,住院病死率也较低 (11.4%比 15 .7% ,P<0 .0 5 ) ,AP组梗塞前正规治疗者多于对照组 (5 8.4%比 2 9.1% ,P<0 .0 0 1) ,患高血压者也较多(5 3.1%比 41.2 % ,P<0 .0 0 1) ,但大面积梗塞较少 ,肌酸激酶峰值较低。结论 : 长期心肌缺血可能也有缺血预适应作用 ,有益于 AMI的近期预后 相似文献