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題名 | 如何面對急性冠狀動脈性心臟病症候群(Acute Coronary Syndrome)--從病理生理機轉看抗血小板及抗凝血藥物的原理及角色=Critical Care and Management of Acute Coronary Syndrome--The Roles of New Anti-Platelet and Anti-Coagulation Therapies |
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作者 | 劉秉彥; 蔡良敏; 陳志鴻; | 書刊名 | 中華民國重症醫學雜誌 |
卷期 | 5:4 2003.12[民92.12] |
頁次 | 頁263-273 |
分類號 | 415.31 |
關鍵詞 | 急性冠狀動脈性心臟病症候群; 血小板凝集抑制劑; 血小板表面接受器拮抗劑; 低分子量肝素; 預後; Acute coronary syndrome; Glycoprotein Ⅱb/Ⅲa receptor inhibitor; Anti-platelet therapy; Low-molecular-weight heparin; Prognosis; |
語文 | 中文(Chinese) |
中文摘要 | 過去數年來,隨著分子生物路究的進步,使得我們對急性冠狀動脈性心臟病症候群(急性冠心症)的致病機轉有了大皮的了解。大體而言,它們是因急性的氣氧供需失衡,並經由粥狀動脈血斑塊的破裂及一連串的發炎反應、血栓形成、血管收縮及微小的血管栓塞,如同加重了此項缺氧反應所形成。治療方針著重在抑制血小板凝集的能力,抵抗凝血機轉活化,冠狀動脈血管擴張劑及減少氧氣需求量四方面。此外,在診斷急性冠心症方面也有著長足的進步,其中包括:troponin-Ⅰ,troponin-T及C-reactive protein的運用,更使得我們對急性冠心症的危險度評估及預後的了解方面提升不少。在新藥的發展與開發上,抗血小板及抗凝血劑的藥物研究皮結果尤其突出。在實症醫學的時代,這些經過臨床試驗及大型臨床治療計畫考驗下的治療藥物,相信不僅會幫助重症醫師在處理急性冠心症上憑添利器,而且也將為急性冠心症的患者帶來治療的契機。本文將近年來對於急性冠心症的致病機轉、診斷方式及新研發的抗血小板及抗凝血藥物的研究發展作一回顧及探討,以利重症醫師處理急性冠心症病患時有所依據。 |
英文摘要 | For many years, unstable angina has been considered as an intermediate “syndrome” between chronic stable angina and acute myocardial infraction. In recent years, its physiopathology has been clarified and there have been major advances in the management. It is now apparent that the “acute coronary syndrome” may result from an acute or subacute primary reduction of myocardial oxygen supply provoked by disruption of an atherosclerotic plaque associated with inflammation, thrombosis, vasoconstriction and microembolization. The newly developed diagnostic tools, including cardiac troponin-I, troponin-T or C-reactive protein, not only facilitate the diagnostic accuracy of acute coronoary syndrome, but also improve the strategy of management among high-risk patients. In respect of treatment, anti-platelet and anticoagulation therapies are two of the recent-advanced medications with important results of clinical trials. In this review article, we analyze the result from several large-scale clinical trials with medications for the management of acute coronary syndrome. They include the ADP receptor antagonists and glycoprotein Ⅱb/Ⅲa receptor inhibitors for anti-platelet therapies, low-molecular-weight heparin or unfractionated heparin for anti-coagulation therapies. For critical care team, we should be able to recognize the high-risk population among patients with acute coronary syndrome. Furthermore, we should choose the most effective and safety therapy according to the results of updated clinical trials or guidelines, especially in this evidence-based medicine era. |
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