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相關文獻
- 急性心肌梗塞診斷與處置之新進展
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題 名 | 急性心肌梗塞診斷與處置之新進展=New Insight to the Management of Acute Myocardial Infarction |
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作 者 | 陳明豐; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 1:1 1999.10[民88.10] |
頁 次 | 頁62-70 |
分類號 | 415.3161 |
關鍵詞 | 急性心肌梗塞; 主動脈剝離; Acute myocardial infarction; Aortic dissection; |
語 文 | 中文(Chinese) |
中文摘要 | 重症醫學的醫師必須對於急性心肌梗塞(acute myocardial infarction,AMI)的診斷及治療,相關病症的鑑別診斷,併發症的認知和處置,心因性休克的積極治療等,有熟悉的認識及熟練的處理能力。 急性心肌梗塞的診斷,主要基於下列三項標準,有兩個成立即成立:缺氧性胸痛表現、心電圖變化及心臟肌肉酵素的異常昇高及下降,但並非每個病人都是典型變化。20%∼30%的病人並沒有典型的心絞痛或者根本沒有胸痛的出現。也有50%的病人,其心電圖並無ST elevation、Q wave或BBB pattern。心臟酵素(CK及CK-MB)的上昇及下降,必須考慮其上昇的程度及時間,因此診斷上有時頗費心思。急性心肌梗塞的治療包括來院前、急診處及加護病房及一般病房等環節,迅速而正確的診斷為前提,精確而有效的治療為重點。並應考慮是否應給予積極的再灌流治療(reperfusion therapy),如血栓溶解療法、逕行經皮冠狀動脈氣球擴張術(primary PTCA),甚至冠戕動脈繞道手術等。心因性休克是AMI後高死亡率的併發症,除了內科療法外,可能還必須借助醫療器械以支持左心室功能或外科手術治療。 AMI有許多鑑別診斷, 特別是主動脈剝離,臨床表現呈多樣性,不易診斷; 且治療方向與AMI完全不同(前者不能用thrombolytic therapy,而後者可能需要)。唯有保持高度之懷疑心及安排適當的檢查(CT、TEE、MRI)才能迅速診斷,把握治療良機。 |
英文摘要 | It is essential for the doctors of critical care medicine to be familiar with the diagnosis, treatment, differential diagnosis, and management of the complications of acute myocardial infarction (AMI). The diagnosis of AMI is established if two of the following three criteria are positive: ischemic chest pain, diagnostic electrocardiographic (ECG) changes, and rise and fall of cardiac enzymes. However, it is impossible for every patient to meet the criteria exactly. A typical chest pain, compromised ECG patterns, and low magnitude and/or timing delay for the rise and fall of cardiac enzymes always disturbs accurate and prompt management of AMI. Furthermore, some cardiovascular diseases have similar symptoms, ECG changes and low-grade elevation of cardiac enzymes. The treatment of AMI includes pre-hospital care, management at emergency service, coronary care unit, and general ward. Antiplatelet therapy and prompt reperfusion therapy using thrombolytic agents or primary percutaneous transluminal coronary angioplasty should always be considered. The treatment of cardiogenic shock is a big challenge. In addition to medical manuals, mechanical devices to support left ventricular function or even emergent coronary bypass surgery are useful. Risk stratification for AMI patients is rational if based on left ventricular function. However, other risk factors control is also an important determinate. The most important differential diagnosis of AMI is aortic dissection. Although most of patients with aortic dissection have hypertension, the symptoms of aortic dissection is variable and not specific, which including cardiac, chest, cerebral, or neurological complaints, acute abdomen, or ischemic extremities. The use of thrombolytic therapy in aortic dissection is hazard, thus it is very important to make an accurately differential diagnosis with AMI. High index of suspicious is the key to have a good diagnosis of aortic dissection. Emergent computer tomography or echocardiography may offer a good diagnostic information. |
本系統中英文摘要資訊取自各篇刊載內容。