医学ppt--急性冠脉综合征疗的新视点.ppt

不能行急诊PCI的医院 ① 高危STEMI患者在溶栓后应尽快转送到可行急诊PCI的医院，必要时行PCI或采取相应的药物治疗（Ⅱa，B）。 ② 非高危患者在溶栓治疗后也应尽快转送至可行急诊PCI医院，必要时行PCI治疗或采取相应的药物治疗。（Ⅱb，C）。 ③ 适于尽快转送的患者包括：高危患者、溶栓治疗出血风险高、症状发作4 h后就诊的患者。低危患者也应在溶栓后考虑转送，特别是症状持续，怀疑溶栓失败的患者。 ④出血风险低、就诊早的患者适于就地溶栓。 AMI患者急救网络的问题 * Performance is most often the work of many – even when it appears to bethe result of an individual. Patients Transported by EMS After Calling 9-1-1 Onset of STEMI Symptoms Call 911 Call Fast 9-1-1 EMS Dispatch EMS on-scene Encourage 12-lead ECG Consider prehospital fibrinolytic if capable and EMS-to-needle 30 min EMS Triage Plan Not PCI Capable Hospital PCI Capable Hospital Interhospital Transfer Hospital Fibrinolysis: Door-to-needle within30 min EMS transport:EMS to Balloon within 90 min Patient self-transport: Hospital Door-to-Balloon within 90 min EMS transport EMS on scene Within 8 min Dispatch 1 min Patient 5 min after Symptom onset Goals Total ischemic time: Within 120 min* * Golden hour = First 60 min Adapted from Panel A Figure 1 Antman et al. JACC 2004;44:676. 建立区域性STEMI救治系统 其职能包括 建立与院前和院内处理流程（I，C） 定期组织召开协调会，参会成员包括急救医疗系统、未开展急诊PCI医院和可行急诊PCI的医院，目的是提高医疗质量。 * Evolution of Guidelines for Management of Patients with AMI The first guideline published by the ACC/AHA described the management of patients with acute myocardial infarction (AMI). The subsequent three documents were the Agency for Healthcare and Quality/National Heart, Lung and Blood Institute sponsored guideline on management of unstable angina (UA), the revised/updated ACC/AHA guideline on AMI, and the revised/updated ACC/AHA guideline on unstable angina/non-ST segment myocardial infarction (UA/NSTEMI), and the revised/updated ACC/AHA guideline on STEMI. The present guideline is a update of the management of patients presenting with ST segment elevation myocardial infarction (STEMI) and percutaneous coronary intervention (PCI). The names of the chairs of the writing committees for each of the guidelines are shown at the bottom of each b