内科学课件_冠心病心绞痛.ppt.ppt

抗栓治疗 抗血小板药 ( Antiplatelet agents ) 阿斯匹林:通过抑制血小板内的环氧化酶，使血栓素合成减 少,75~300mg/日 氯比格雷( clopidogrel ,波立维 ):抑制ADP诱导的血小板聚集 75mg日 血小板Ⅱb/Ⅲa拮抗剂: PTCA术应用防止再狭窄 抗凝药( Anticoagulation therapy ) 肝素 (heparin)，50 ~ 100mg/日 低分子肝素（速避凝）(LMWH)，0.4ml, bid 皮下注射 * 高危患者 糖蛋白IIb/IIIa抑制剂 急性冠脉造影 肝素治疗，直至造影 连续给予糖蛋白 IIb/IIIa抑制剂至造影后12–24小时 低危患者 内科处理（抗血小板药物，硝酸酯，? – 受体阻滞剂） 出院前或出院后行负荷试验 所有病例 阿司匹林，硝酸酯，? – 受体阻滞剂，肝素 Bertrand ME et al Eur Heart J 2000;21:1406–1432 Braunwald E et al J Am Coll Cardiol 2000;36:970–1062 不稳定性心绞痛指南总诣 * * * Atherosclerosis is a complex disease. Atherosclerotic plaques can be subdivided in accordance with their age and state of development. It is the newly formed lesions with a large lipid core, thin capped, which are fragile and therefore likely to rupture and lead to an acute ischemic event. * Slide 3 Atherothrombosis: a Generalized and Progressive Process Atherothrombosis is the common underlying disease process for MI, ischemia and vascular death. ACS are classic examples of atherothrombosis (plaque rupture and thrombus formation). ACS (in common with ischemic stroke and critical leg ischemia) are typically caused by rupture or erosion of an atherosclerotic plaque followed by formation of a platelet-rich thrombus. Atherosclerosis is an ongoing process affecting mainly large and medium-sized arteries, which can begin in childhood and progress throughout a person’s lifetime. Stable atherosclerotic plaques may encroach on the lumen of the artery and cause chronic ischemia, resulting in (stable) angina pectoris or intermittent claudication, depending on the vascular bed affected. Unstable atherosclerotic plaques may rupture, leading to the formation of a platelet-rich thrombus that partially or completely occludes the artery and causes acute ischemic symptoms. * Slide 19 Overview of Unstable Angina Guidelines The new US and European guidelines for the management of unstable angina and non-Q-