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頁籤選單縮合
題名 | 急性冠心症治療之新趨勢=New Trends in Management of Acute Coronary Syndromes |
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作者 | 林世崇; 林廷燦; 羅鴻舜; 朱凱民; 張之光; | 書刊名 | 中華民國急救加護醫學會雜誌 |
卷期 | 8:2 1997.06[民86.06] |
頁次 | 頁63-75 |
分類號 | 415.31 |
關鍵詞 | 急性冠心症; 急性心肌梗塞; 高級心臟救命術; 血栓溶解劑治療; 經皮冠狀動脈擴張術; Acute coronary syndromes; Acute myocardial infarction; Advanced cardiac life support; ACCS; Thrombolytic therapy; Percutaneous coronary angioplasty; PTCA; |
語文 | 中文(Chinese) |
中文摘要 | 急性冠心症包括不穩定狹心症,無Q波心肌梗塞及有Q波心肌梗塞。在不同之診斷下,其臨床處置亦不同。高級心臟救命術,在1992年有一章急性心肌梗塞之章節。1997年7月時,重新修訂,提出「急性冠心症」之新章節。在此章節內,對於急性冠心症之處置作了詳細說明。其中強調,到院前之初步評估,是否合乎血栓溶解劑治療之要件;並提出,在救護途中先與醫院聯絡診斷,並考慮在救護車上,注射血栓溶解劑。對於病人之評估,並列舉高危險性病人。如果超過12小時之血栓溶解劑治療時機,應考慮直接經皮冠狀動脈擴張術或冠狀動脈手術之治療。除了血流再通之治療,應同時合併其他藥物治療,包括乙型阻斷劑,靜脈注射硝化甘油,及血管升壓素轉化酵素抑制劑。如困病人並無明顯急性心肌梗塞之心電圖及臨床發現,則在急診繼續觀察,連續系列檢查心電圖、血清心肌酵素及心臟影像之檢查。8至12小時後,確定無心肌梗塞,刖病人可出院。 |
英文摘要 | The new chapters of advanced cardiac life support (ACLS)include acute coronary syndromes and acute stroke. The three major subsets of acute coronary syndromes are unstable angina, non-Q-wave myocardial infarction, and Q-wave myocardial infarction, which are clearly explored in the 1997 new edition of ACLS. It stresses the prehospital emergency management, including initial assessment, and thrombolytic therapy exclusion eriteriea. Reperfusion therapy is recommended early in the management of patients with ST elevation or a new left bundle branch block, if the symptoms are less than 12 hours old. High risk patients must be sought out to consider the further steps for revascularization. Primary percutaneous coronary angioplasty in high risk patients can be performed, but only based on specified "corridor of outcomes" and requires other stringent conditions. Conjunctive and adjunctive treatment with morphine, oxygen, nitroglycerin, beta-blockers, aspirin, heparin, angiotensin converting enzyme inhibitors should always be given if there are no contraindications. In cases of acute chest pain not presenting with diagnostic features, the patients should receive continuous ECG monitoring and serial 12-lead ECG serum markers, and cardiac imaging studies in the emergency department over 8-12 hours to assis in making an appropriate disposition. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。