李丽君-急性心肌梗死摘要.ppt

Angiography before and after thrombolysis The studies confirmed that thrombolysis can achieve early, complete and continuous opening of coronary artery。 （研究证实，溶栓使冠状动脉早期、完全、持续地开通。） Clinic trail - thrombolysis of AMI Recanalization of the occluded coronary vessel。 （闭塞的冠脉血管再通） Reducing infarct size and improves myocardial function。（减少心肌梗死的面积，改善心脏功能） Reducing mortality rate after MI。（降低死亡率） ---- from 9 large prospective double-blind placebo controlled trials 80年代：溶栓治疗——成为AMI治疗主线，是AMI治疗史对死亡率下降最显著的治疗。 GISSI试验：AMI后1小时溶栓死亡率下降近 50%; ISIS试验：AMI后4小时溶栓死亡率下降近 53%； 9个AMI溶栓试验：AMI在6小时内死亡率下降 20%; When do we give thrombolysis ? (急性心肌梗塞溶栓时间？) Time of Thrombolysis of From Onset of Symptoms Time from onset of symptoms to fibrinolytic therapy is an important predictor. The efficacy of fibrinolysis of MI size and patient outcome. Lytic agents in lysing thrombus diminishes with the passage. Fibrinolytic therapy administered within the first of time. 2 hours(especially the first hour) can occasionally abort MI and dramatically reduce mortality. -----AHA/ACC 2004 Guideline 溶栓的时间 Usually in 12 hours of pain Emphasize in 3 hours of pain The best time is in golden first hour of pain When? The animal researches After 20 minutes of occlusion of artery, the MI proceeds from the endothelial member to the pericardial member like wave. After 6 hours：over 70% myocardium is dead. After 6-24 hours：only a few myocardium is alive. The time of thrombolysis and  the number of saved patients The time of thrombolysis and mortality 2007 ACC/AHA指南提出，溶栓时间强调在3小时以内，更要求从“门到溶栓针”时间是30分钟内。 2007 ACC/AHA指南从“门到导管”时间是90分钟；2004欧洲指南是60分钟。 无论是溶栓还是导管介入治疗时间规定，目的是减少心肌死亡。 图A.血栓头部，B.血栓体部。2：箭头显示头体部的交界。血栓形成后24小时产生纤维帽，阻碍溶栓药进入血栓。（1.放大10×10倍，曝光900毫秒，2. 放大10×20倍，曝光900毫秒） 我们自己有关血栓试验 Time is heart ! time is life ! Thrombolysis of Acute Myocardial Infaction 李丽君 西安交通大学医学院第二附属医院 急诊医学系 急性心肌梗死溶栓治疗 急性ST段抬高心肌梗死是真正的急诊 循证医学的触角已伸到了急诊 急性心肌梗塞指南已纳入急诊的内容 急性心梗是真正的急诊，处理更注