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題名 | 急性冠狀症候群之治療=Current Treatment in Acute Coronary Syndrome |
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作者 | 謝宜璋; Hsieh, I-chang; |
期刊 | 中華民國重症醫學雜誌 |
出版日期 | 20031200 |
卷期 | 5:4 2003.12[民92.12] |
頁次 | 頁291-296 |
分類號 | 415.3161 |
語文 | chi |
關鍵詞 | 急性冠狀症候群; 治療; 經皮冠狀動脈介入性治療; Acute coronary syndrome; Treatment; Percutaneous coronary interventions; |
中文摘要 | 急性冠狀症候群的定義乃泛指處於急性心肌缺氧的狀態,因此其範圍包括1. 不穩定型心絞痛;2.非ST段升高之心肌梗塞;3.ST段升高之心肌梗塞。在急性期時,可先給予基本的處置,如臥床休息、給予氧氣、予止痛藥公減輕胸痛症狀,及給予一些抗心肌缺氧的藥物,如nitrate、β-blocker等。對於有ST段升高的心肌梗塞病患,可給予血栓溶劑(thrombolytic therapy)或做緊急之血管成形術(primary angioplasty),兩者皆具療效,但後都之療效似乎更佳。對於低危險群的不穩定型心絞痛或ST段未上升之心肌梗塞病患可給予aspirin、clopidogrel、heparin或low-molecular-weight heparin(LMWH),早期可採取較保守的治療策略。但是對於中高危險群的病患,除了aspirin、clopidogrel、heparin或LMWH外,給予platelet glycoprotein Ⅱb/Ⅲa inhibitor也是有幫助的。對於這類病患,早期的治療策略可以採取更積極的侵襲性心導管檢查及治療。 |
英文摘要 | The term “acute coronary syndrome” refers to range of acute myocardial ischemic states. It compasses unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI), and ST-segment elevation infarction (STEMI). The pathogenesis of an acute coronary syndrome is disruption of an athermanous plaque, and consequent exposure of core constituents such as lipid, smooth muscle, and foam cells0leads to the local generation of thrombin, deposition of fibrin and intracoronary thrombus. For the patients with STEMI, there are two main methods of re-opening an occluded artery: administering a thrombolytic agent or primary angioplasty. Primary angioplasty offers a superior alternative to thrombolytic in the immediate treatment. For the low-risk patients with UA/NSTEMI, medical treatment in acute stage includes bed rest, oxygen, opiate analysis to relief pain, anti-ischemic, and anti-thrombotic drugs. Anti-ischemic drugs include intravenous, oral or buccal nitroglycerin, β-blockers, and calcium channel antagonists. Anti-thrombotic drugs include aspirin, clopidogrel, intravenous unfractionated heparin or low-molecular-weight heparin. For the high-risk patients with UA/NSTEMI, medications should include the above drugs and platelet glycoprotein Ⅱb/Ⅲa inhibitors. The benefit of the early invasive strategy also was seen in high-risk patients. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。