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\u975e\u81f4\u547d\u6027\u5fc3\u808c\u6897\u6b7b\u7684\u53d1\u751f\u7387\u3002\u5bf9\u4e8e\u4f4e\u5371\u7684\u60a3\u8005\uff0c\u5e94\u7528\u4f9d\u8bfa\u809d\u7d20\u83b7\u76ca\u6709\u9650\u3002TIMI \u5371\u9669\u5206\u5c42\u7cfb\u7edf\u4e0e\u4e0a\u8ff0\u4e24\u79cd\u65b9\u6cd5\u7684\u4e00\u4e2a\u663e\u8457\u7684\u533a\u522b\u5728\u4e8e\u672a\u5305\u62ec\u5fc3\u8870\u548c\u8840\u6d41\u52a8\u529b\u5b66\u56e0\u7d20\u5982\u8840\u538b\u548c\u5fc3\u7387\uff0c\u8fd9\u4e24\u7c7b\u56e0\u7d20\u5728\u65e2\u5f80\u7684\u7814\u7a76\u4e2d\u88ab\u8ba4\u4e3a\u662f\u6b7b\u4ea1\u7684\u91cd\u8981\u9884\u6d4b\u6307\u6807\uff0c\u672a\u5305\u542b\u8fd9\u4e24\u9879\u91cd\u8981\u56e0\u7d20\u867d\u7136\u4f7f\u65e9\u671f\u8bc4\u4f30\u66f4\u4e3a\u7b80\u5355\u5feb\u6377\uff0c\u4f46\u662f\u5bf9\u6b7b\u4ea1\u98ce\u9669\u7684\u9884\u6d4b\u4ef7\u503c\u964d\u4f4e\u4e86\u3002\u53e6\u5916\u5bf9\u4e8e\u4ee5\u524d\u672a\u63a5\u53d7\u8fc7\u51a0\u72b6\u52a8\u8109\u9020\u5f71\u7684\u60a3\u8005\uff0c\u65e0\u6cd5\u786e\u5b9a\u662f\u5426\u5b58\u5728\u5927\u4e8e50% \u7684\u51a0\u8109\u72ed\u7a84\uff0c\u8fd9\u9650\u5236\u4e86TIMI \u5371\u9669\u5206\u5c42\u7cfb\u7edf\u7684\u5e94\u7528\u3002<\/p>\n\n\n\n

\u4e0a\u8ff0\u4e09\u79cd\u5371\u9669\u5206\u5c42\u65b9\u6cd5\u5747\u5c06CK \u6216CK-MB \u4f5c\u4e3a\u5fc3\u808c\u635f\u4f24\u7684\u6807\u5fd7\uff0c\u7136\u800c\u6240\u6709\u8fd1\u671f\u63a8\u51fa\u7684\u5371\u9669\u5206\u5c42\u65b9\u6cd5\u5df2\u5c06\u808c\u9499\u86cb\u767dI \uff08c-TnI\uff09\u6216c-TnT \u53d6\u4ee3CK-MB\uff0c\u9664\u4e86\u56e0\u4e3a\u524d\u8005\u5177\u6709\u66f4\u9ad8\u7684\u654f\u611f\u6027\u548c\u7279\u5f02\u6027\u4ee5\u5916\uff3b6\uff3d\uff0c\u5927\u91cf\u7814\u7a76\u8868\u660e\u65e0\u8bba\u628ac-TnI \u6216c-TnT \u4f5c\u4e3a\u8fde\u7eed\u53d8\u91cf\u5206\u6790\u8fd8\u662f\u5e94\u7528\u67d0\u4e00\u5207\u70b9\uff08\u5982\u22650. 1ng \/ ml\uff09\u5c06\u5176\u53d8\u4e3a\u4e8c\u5206\u53d8\u91cf\uff08\u9633\u6027\u6216\u9634\u6027\uff09\u5206\u6790\uff0c\u5176\u5347\u9ad8\u90fd\u662f\u8fd1\u671f\u6216\u4e2d\u8fdc\u671f\u9884\u540e\u4e0d\u826f\u7684\u6807\u5fd7\uff3b7\uff0c8\uff3d\uff0c\u800c\u5305\u62ec\u65e9\u671f\u4ecb\u5165\u6cbb\u7597\u4ee5\u53ca\u5e94\u7528\u8840\u5c0f\u677fGP\u2161b \/\u2162a\u53d7\u4f53\u62ee\u6297\u5242\u5728\u5185\u7684\u5f3a\u5316\u6cbb\u7597\u53ef\u6539\u5584\u8fd9\u90e8\u5206\u60a3\u8005\u7684\u9884\u540e\u3002\u9759\u8109\u5e94\u7528\u8840\u5c0f\u677fGP\u2161b \/\u2162a \u53d7\u4f53\u62ee\u6297\u5242\u662f\u6539\u5584NSTEACS \u60a3\u8005\u9884\u540e\u7684\u91cd\u8981\u6cbb\u7597\u3002\u4e34\u5e8a\u8bd5\u9a8c\u63d0\u793a\u4ec5\u5728\u808c\u9499\u86cb\u767d\u6c34\u5e73\u5347\u9ad8\u6216\u63a5\u53d7\u4ecb\u5165\u6cbb\u7597\u7684ACS \u60a3\u8005\u53ef\u6539\u5584\u9884\u540e\u3002CAPTURE \u7814\u7a76\u8868\u660e\u963f\u6614\u5355\u6297\u53ef\u964d\u4f4eTnT \u9633\u6027\u7684ACS \u60a3\u80056 \u4e2a\u6708\u6b7b\u4ea1\u6216\u975e\u81f4\u6b7b\u6027\u5fc3\u808c\u6897\u6b7b\u7684\u53d1\u751f\u7387\uff0c\u5bf9\u4e8eTnT \u9634\u6027\u7684ACS \u60a3\u8005\u65e0\u6b64\u4f5c\u7528\uff3b9\uff3d\u3002\u53e6\u4e00\u9879\u7814\u7a76\u53d1\u73b0\u65e0\u8bba\u662fTnT \u8fd8\u662fTnI \u9633\u6027\u7684\u60a3\u8005\u5e94\u7528\u66ff\u7f57\u975e\u73ed\uff0c\u5747\u53ef\u4f7f30 d \u6b7b\u4ea1\u7387\u964d\u4f4e\uff3b10\uff3d\u3002\u56e0\u6b64\u6709\u4eba\u63d0\u51fa\u5982\u540cST \u6bb5\u62ac\u9ad8\u662f\u5fc3\u808c\u6897\u6b7b\u6eb6\u6813\u6cbb\u7597\u7684\u6307\u5f81\u4e00\u6837\uff0cTnT\u6216TnI \u7684\u5347\u9ad8\u662f\u5e94\u7528\u8840\u5c0f\u677fGP\u2161b \/\u2162a \u53d7\u4f53\u62ee\u6297\u5242\u7684\u6307\u5f81\u3002\u8840\u5c0f\u677fGP\u2161b \/\u2162a \u53d7\u4f53\u62ee\u6297\u5242\u5728\u9884\u671f\u63a5\u53d7\u4ecb\u5165\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\u4ef7\u503c\u5c24\u4e3a\u660e\u786e\u3002ACC \/ AHA 2002 \u5e74UAP \/ NSTEMI \u6307\u5357\uff3b11\uff3d\u4e2d\u6307\u51fa\u8840\u5c0f\u677fGP\u2161b \/\u2162a \u53d7\u4f53\u62ee\u6297\u5242\u5bf9\u63a5\u53d7\u4ecb\u5165\u6cbb\u7597\u7684\u60a3\u8005\u6709\u660e\u786e\u7684\u76ca\u5904\uff08\u2160\u7c7b\u9002\u5e94\u8bc1\uff0c\u8bc1\u636e\u6c34\u5e73A\uff09\uff0c\u800c\u5bf9\u4e8e\u4e0d\u884c\u4ecb\u5165\u6cbb\u7597\u7684\u9ad8\u5371\u60a3\u8005\u5e94\u7528\u66ff\u7f57\u975e\u73ed\u6216\u4f9d\u66ff\u5df4\u80bd\u4e3a\u2161a \u9002\u5e94\u8bc1\uff08 \u8bc1\u636e\u6c34\u5e73A\uff09\uff0c\u5bf9\u4e8e\u65e0\u6301\u7eed\u6027\u7f3a\u8840\u6216\u9ad8\u5371\u56e0\u7d20\u5e76\u4e14\u4e0d\u8ba1\u5212\u63a5\u53d7\u4ecb\u5165\u6cbb\u7597\u7684\u60a3\u8005\u5e94\u7528\u66ff\u7f57\u975e\u73ed\u6216\u4f9d\u66ff\u5df4\u80bd\u4e3a\u2161b \u7c7b\u9002\u5e94\u8bc1\uff0c\u5e94\u7528\u963f\u6614\u5355\u6297\u4e3a\u2162\u7c7b\u9002\u5e94\u8bc1\u3002\u8fd9\u4e9b\u5efa\u8bae\u7684\u57fa\u7840\u662fPRISM\u3001PROSM-PLUS\u3001URSUIT \u4ee5\u53caGUSTO IV \u7b49\u5927\u89c4\u6a21\u968f\u673a\u5bf9\u7167\u4e34\u5e8a\u8bd5\u9a8c\u4ee5\u53ca\u835f\u8403\u5206\u6790\u3002\u56e0\u6b64\u76ee\u524d\u591a\u5728\u63a5\u53d7\u4ecb\u5165\u6cbb\u7597\u7684\u9ad8\u5371NSTEACS \u60a3\u8005\u5e94\u7528\u9759\u8109\u8840\u5c0f\u677fGP\u2161b \/\u2162a \u53d7\u4f53\u62ee\u6297\u5242\u3002<\/p>\n\n\n\n

\u65e9\u671f\u4ecb\u5165\u6cbb\u7597\u662f\u5426\u53ef\u4f7fUAP \/ NSETMI \u60a3\u8005\u83b7\u76ca\u6539\u5584\u5176\u9884\u540e\u4e00\u76f4\u662f\u5173\u6ce8\u7684\u7126\u70b9\u3002\u5bf9\u4e8e\u65e9\u671f\u5371\u9669\u5206\u5c42\u9009\u62e9\u9002\u5408\u65e9\u671f\u4ecb\u5165\u6cbb\u7597\u7684\u9ad8\u5371\u60a3\u8005\uff0c\u5404\u4e13\u4e1a\u5b66\u4f1a\u5236\u5b9a\u7684\u6307\u5357\u5177\u6709\u8f83\u9ad8\u7684\u53c2\u8003\u4ef7\u503c\uff0c\u800c\u8fd9\u4e9b\u6307\u5357\u7684\u66f4\u65b0\u662f\u4ee5\u5927\u89c4\u6a21\u4e34\u5e8a\u8bd5\u9a8c\u7684\u7814\u7a76\u7ed3\u679c\u4e3a\u57fa\u7840\u7684\u3002\u65e9\u671f\u7684TIMI \u2162B\uff3b12\uff3d\u7814\u7a76\u548cVANQWISH \u7814\u7a76\uff3b13\uff3d\u4ee5\u6b7b\u4ea1\u6216\u518d\u53d1\u5fc3\u808c\u6897\u6b7b\u4f5c\u4e3a\u590d\u5408\u7ec8\u70b9\uff0c\u672a\u663e\u793a\u65e9\u671f\u4ecb\u5165\u6cbb\u7597\u4f18\u4e8e\u65e9\u671f\u4fdd\u5b88\u6cbb\u7597\uff0cVANQWISH \u7814\u7a76\u751a\u81f3\u53d1\u73b0\u4ecb\u5165\u6cbb\u7597\u6709\u66f4\u9ad8\u76841\u5e74\u6b7b\u4ea1\/ \u5fc3\u808c\u6897\u6b7b\u53d1\u751f\u7387\uff08 32. 9% vs. 30. 3%\uff0cP =0. 35\uff09\u3002\u4f46\u662f1996 \u5e74\u4ee5\u540e\u5728\u9ad8\u5371\u60a3\u8005\u4e2d\u5b8c\u6210\u7684\u4e09\u9879\u91cd\u8981\u7814\u7a76\uff08FRISC \u2161\u3001TACTICS-TIMI 18 \u548cRITA-3\uff09\u5747\u53d1\u73b0\u65e9\u671f\u4ecb\u5165\u6cbb\u7597\u4f18\u4e8e\u65e9\u671f\u4fdd\u5b88\u6cbb\u7597\u30026 \u4e2a\u6708\u52301 \u5e74\u4ee5\u6b7b\u4ea1\/ \u5fc3\u808c\u6897\u6b7b\u6216\u5408\u5e76\u96be\u6cbb\u6027\u5fc3\u7ede\u75db\u7684\u590d\u5408\u7ec8\u70b9\u53d1\u751f\u7387\u8f83\u4f4e\u30021998 \u5e74\u5b8c\u6210\u7684FRISC \u2161\u7814\u7a76\u5171\u5165\u90092 457 \u4f8b\u60a3\u8005\uff0c\u5165\u9009\u6807\u51c6\u5305\u62ec\uff081\uff09\u7f3a\u8840\u75c7\u72b6\u5728\u9759\u606f\u65f6\u53d1\u4f5c\uff0c\u6216\u75c7\u72b6\u52a0\u91cd\uff1b\uff082\uff09\u5fc3\u808c\u7f3a\u8840\u662f\u7531\u5fc3\u7535\u56fe\u6539\u53d8\uff08 ST \u6bb5\u538b\u4f4e\u22650. 1mV \u6216T \u6ce2\u5012\u7f6e\u22650. 1mV\uff09\u6216\u751f\u5316\u6807\u5fd7\u7684\u5347\u9ad8\uff08CKMB> 6\u03bcg \/ L \u6216TnT > 0. 1ng \/ ml\uff09\u5224\u65ad\u7684\u3002\u663e\u7136\u8fd9\u4e00\u5165\u9009\u6807\u51c6\u6240\u5b9a\u4e49\u7684\u662f\u9ad8\u5371\u7684NSTEACS \u60a3\u8005\u3002\u60a3\u8005\u968f\u673a\u5206\u5165\u65e9\u671f\u4ecb\u5165\u7ec4\u548c\u65e9\u671f\u4fdd\u5b88\u7ec4\u3002\u5c3d\u7ba1\u65e9\u671f\u4fdd\u5b88\u7ec4\u4e5f\u670917. 8%\u7684\u60a3\u8005\u5728\u5165\u9009\u5e73\u574716. 5 d \u540e\u63a5\u53d7\u4e86\u4ecb\u5165\u6cbb\u7597\uff08\u5728\u65e9\u671f\u4ecb\u5165\u7ec4\u8fd9\u4e00\u6bd4\u4f8b\u662f42. 7%\uff0c\u5728\u5165\u9009\u5e73\u57474 d \u540e\u63a5\u53d7\u4ecb\u5165\u6cbb\u7597\uff09\uff0c\u5728\u5b8c\u6210\u968f\u8bbf\u65f6\u5fc3\u808c\u6897\u6b7b\u6216\u6b7b\u4ea1\/ \u5fc3\u808c\u6897\u6b7b\u590d\u5408\u7ec8\u70b9\u7684\u53d1\u751f\u7387\u4ecd\u7136\u663e\u8457\u9ad8\u4e8e\u65e9\u671f\u4ecb\u5165\u7ec4\uff08\u5fc3\u808c\u6897\u6b7b10. 1% vs. 7. 8%\uff0cP = 0. 045\uff1b\u5fc3\u808c\u6897\u6b7b\/ \u6b7b\u4ea112. 1% vs. 9. 4%\uff0cP = 0. 031\uff09\uff3b14\uff3d\u3002\u8fd9\u4e00\u4e0e1996 \u5e74\u4ee5\u524d\u5b8c\u6210\u7684TIMI \u2162B \u548cVANQUISH \u7814\u7a76\u7ed3\u679c\u7684\u5dee\u5f02\u53ef\u4ee5\u7528\u652f\u67b6\u7684\u5e7f\u6cdb\u5e94\u7528\u3001\u8840\u5c0f\u677fGP\u2161b \/\u2162a \u7684\u5e94\u7528\u4ee5\u53ca\u4ecb\u5165\u6280\u672f\u7684\u8fdb\u6b65\u6765\u89e3\u91ca\u3002\u57fa\u4e8e\u4e0a\u8ff0\u7814\u7a76\u7ed3\u679c\uff0cACC \/ AHA2005 \u5e74\u7ecf\u76ae\u51a0\u72b6\u52a8\u8109\u4ecb\u5165\u6cbb\u7597\uff08 PCI\uff09\u6307\u5357\uff3b15\uff3d\u4e2d\u5efa\u8bae\u65e9\u671f\u4ecb\u5165\u6cbb\u7597I \u7c7b\u9002\u5e94\u8bc1\u5305\u62ec\u4ee5\u4e0b\u9ad8\u5371\u56e0\u7d20\u7684\u4efb\u4f55\u4e00\u6761\uff1a\uff081\uff09\u5f3a\u5316\u6297\u7f3a\u8840\u6cbb\u7597\u57fa\u7840\u4e0a\u4ecd\u6709\u53cd\u590d\u7f3a\u8840\u53d1\u4f5c\uff1b\uff082\uff09\u808c\u9499\u86cb\u767d\u6c34\u5e73\u5347\u9ad8\uff1b\uff083\uff09\u65b0\u51fa\u73b0\u7684ST \u6bb5\u538b\u4f4e\uff1b\uff084\uff09\u5145\u8840\u6027\u5fc3\u8870\u75c7\u72b6\u6216\u65b0\u51fa\u73b0\/ \u52a0\u91cd\u7684\u4e8c\u5c16\u74e3\u53cd\u6d41\uff1b\uff085\uff09\u5de6\u5ba4\u6536\u7f29\u529f\u80fd\u4e0b\u964d\uff1b\uff086\uff09\u8840\u6d41\u52a8\u529b\u5b66\u4e0d\u7a33\u5b9a\uff1b\uff087\uff09\u6301\u7eed\u6027\u5ba4\u901f\uff1b\uff088\uff096 \u4e2a\u6708\u5185\u66fe\u884cPCI\uff1b\uff089\uff09\u65e2\u5f80\u51a0\u72b6\u52a8\u8109\u65c1\u8def\u79fb\u690d\u672f\uff08CABG\uff09\u3002\u4e0a\u8ff0\u6307\u5f81\u7684\u8bc1\u636e\u6c34\u5e73\u5747\u4e3aA \u7ea7\u3002\u5bf9\u4e8e\u65e0\u4e0a\u8ff0\u9ad8\u5371\u56e0\u7d20\u7684\u60a3\u8005\u5219\u9009\u62e9\u65e9\u671f\u4ecb\u5165\u6216\u65e9\u671f\u4fdd\u5b88\u90fd\u662f\u5408\u7406\u7684\u3002\u6211\u4eec\u6ce8\u610f\u5230\u6240\u5217\u51fa\u7684\u524d7 \u9879\u9ad8\u5371\u56e0\u7d20\u5747\u662f\u53cd\u6620\u7f3a\u8840\u7684\u540e\u679c\uff0c\u4efb\u4f55\u4e00\u9879\u5747\u63d0\u793a\u60a3\u8005\u6781\u53ef\u80fd\u8fdb\u4e00\u6b65\u53d1\u751f\u66f4\u4e25\u91cd\u7684\u4e8b\u4ef6\uff0c\u56e0\u6b64\u5b58\u5728\u79ef\u6781\u4ecb\u5165\u6cbb\u7597\u7684\u7d27\u8feb\u6027\u3002\u8fd9\u4e9b\u56e0\u7d20\u4e0eESC 2002 \u5e74UAP \/ NSTEMI \u6307\u5357\uff3b16\uff3d\u6240\u5efa\u8bae\u7684\u9700\u8981\u65e9\u671f\u4ecb\u5165\u6cbb\u7597\u7684\u9ad8\u5371\u56e0\u7d20\u57fa\u672c\u4e0a\u662f\u4e00\u81f4\u7684\uff0c\u53ea\u662f\u4e0d\u5305\u62ec\u5176\u4e2d\u63d0\u53ca\u7684\u7cd6\u5c3f\u75c5\u53f2\u4ee5\u53ca\u5b58\u5728\u65e0\u6cd5\u5224\u65adST\u6bb5\u52a8\u6001\u53d8\u5316\u7684\u5fc3\u7535\u56fe\u5f02\u5e38\u3002\u4e0eACC \/ AHA 2002 \u5e74UAP \/ NSTEMI \u6307\u5357\uff3b17\uff3d\u6240\u5217\u51fa\u7684\u65e9\u671f\u4ecb\u5165\u7684\u6307\u5f81\u57fa\u672c\u76f8\u540c\uff0c\u5220\u9664\u4e86\u8d1f\u8377\u8bd5\u9a8c\u5b9a\u4e49\u7684\u9ad8\u5371\u60a3\u8005\u4e00\u6761\u3002<\/p>\n\n\n\n

\u4f4e\u5371\u60a3\u8005\u7684\u4e34\u5e8a\u8868\u73b0\u4e0d\u5305\u62ec\u4e0a\u8ff0\u9ad8\u5371\u56e0\u7d20\u7684\u4efb\u4f55\u4e00\u6761\uff0c\u75c7\u72b6\u53d1\u4f5c\u65f6\u65e0\u660e\u663e\u7684\u5fc3\u7535\u56fe\u6539\u53d8\uff0c\u4e5f\u65e0\u808c\u9499\u86cb\u767d\u6216\u5176\u5b83\u5fc3\u808c\u635f\u4f24\u7684\u8840\u6e05\u6807\u5fd7\u7269\u6c34\u5e73\u5347\u9ad8\u3002\u8fd9\u4e9b\u60a3\u8005\u8fd1\u671f\u53d1\u751f\u4e25\u91cd\u51a0\u8109\u4e8b\u4ef6\u7684\u98ce\u9669\u8f83\u4f4e\uff0c\u4f46\u5e76\u4e0d\u662f\u8bf4\u4e2d\u8fdc\u671f\u53d1\u751f\u4e25\u91cd\u51a0\u8109\u4e8b\u4ef6\u7684\u98ce\u9669\u540c\u6837\u4e0d\u9ad8\u3002\u56e0\u6b64\u8fd9\u4e9b\u60a3\u8005\u9700\u8981\u5c3d\u65e9\u660e\u786e\u662f\u5426\u5b58\u5728\u53ef\u5bfc\u81f4\u5927\u9762\u79ef\u5fc3\u808c\u7f3a\u8840\u7684\u4e25\u91cd\u51a0\u8109\u75c5\u53d8\u3002\u8fd0\u52a8\u8d1f\u8377\u8bd5\u9a8c\u662f\u8bc4\u4ef7\u7684\u6709\u6548\u624b\u6bb5\u3002\u5305\u62ec\u8fd0\u52a8\u8d1f\u8377\u5fc3\u7535\u56fe\u3001\u8fd0\u52a8\u6216\u836f\u7269\u8d1f\u8377\u8d85\u58f0\u5fc3\u52a8\u56fe\u4ee5\u53ca\u8fd0\u52a8\u6216\u836f\u7269\u8d1f\u8377\u6838\u7d20\u5fc3\u808c\u704c\u6ce8\u65ad\u5c42\u663e\u50cf\u3002\u7279\u522b\u662f\u540e\u4e8c\u8005\u8bca\u65ad\u7684\u654f\u611f\u6027\u548c\u7279\u5f02\u6027\u5747\u8f83\u9ad8\u3002\u5982\u8d1f\u8377\u8bd5\u9a8c\u53d1\u73b0\u7f3a\u8840\u5fc3\u808c\u5360\u5b58\u6d3b\u5fc3\u808c\u768450% \u4ee5\u4e0a\uff0c\u5219\u60a3\u8005\u9700\u8981\u63a5\u53d7\u51a0\u8109\u9020\u5f71\uff0c\u9002\u5408\u7684\u75c5\u53d8\u9700\u8981\u8fdb\u884c\u8840\u8fd0\u91cd\u5efa\u6cbb\u7597\u3002\u5bf9\u4e8e\u7f3a\u8840\u5fc3\u808c\u8f83\u5c11\u7684\u60a3\u8005\u836f\u7269\u6cbb\u7597\u5373\u53ef\u3002\u5bf9\u4e8e\u5371\u9669\u5206\u5c42\u4ecb\u4e8e\u9ad8\u5371\u548c\u4f4e\u5371\u4e4b\u95f4\u7684\u4e2d\u7b49\u5371\u9669\u6027\u60a3\u8005\uff0c\u6307\u5357\u5efa\u8bae\u6536\u5165\u9662\u89c2\u5bdf\uff0c\u5e76\u8fde\u7eed\u76d1\u6d4b\u5fc3\u7535\u56fe\u548c\u5fc3\u808c\u635f\u4f24\u7684\u8840\u6e05\u6807\u8bb0\u7269\u7684\u6539\u53d8\uff0c\u52a8\u6001\u8fdb\u884c\u5371\u9669\u8bc4\u4f30\uff0c\u5982\u53d1\u73b0\u60a3\u8005\u5177\u6709\u4e86\u9ad8\u5371\u60a3\u8005\u7684\u4e34\u5e8a\u8868\u73b0\uff0c\u5219\u53ef\u4ee5\u9009\u62e9\u65e9\u671f\u4ecb\u5165\u6cbb\u7597\u548c\u5f3a\u5316\u6297\u8840\u5c0f\u677f\u6cbb\u7597\u3002\u5982\u60a3\u8005\u75c5\u60c5\u8d8b\u4e8e\u7a33\u5b9a\uff0c\u5219\u53ef\u5728\u5fc5\u8981\u65f6\u8fdb\u884c\u8d1f\u8377\u8bd5\u9a8c\uff0c\u51b3\u5b9a\u662f\u5426\u9700\u8981\u63a5\u53d7\u51a0\u8109\u9020\u5f71\u548c\u8840\u8fd0\u91cd\u5efa\u6cbb\u7597\u3002<\/p>\n\n\n\n

3 ST \u6bb5\u62ac\u9ad8\u7684\u6025\u6027\u51a0\u8109\u7efc\u5408\u5f81\u5371\u9669\u5206\u5c42\u65b9\u6cd5\u53ca\u8bc4\u4ef7<\/p>\n\n\n\n

STEMI \u7684\u75c5\u7406\u57fa\u7840\u662f\u51a0\u8109\u5185\u6025\u6027\u95ed\u585e\u6027\u8840\u6813\u5f62\u6210\uff0c\u5bfc\u81f4\u4f9b\u8840\u8303\u56f4\u5185\u5fc3\u808c\u7684\u900f\u58c1\u6027\u574f\u6b7b\uff0c\u5fc3\u7535\u56fe\u8868\u73b0\u4e3a\u76f8\u5e94\u5bfc\u8054ST \u6bb5\u62ac\u9ad8\u6216\u65b0\u51fa\u73b0\u7684\u5de6\u675f\u652f\u4f20\u5bfc\u963b\u6ede\u3002\u5728\u901a\u8fc7\u75c7\u72b6\u3001\u5fc3\u7535\u56fe\u6539\u53d8\uff08 \u5408\u5e76\u6216\u4e0d\u5408\u5e76\u751f\u5316\u6807\u5fd7\u7684\u5347\u9ad8\uff09\u786e\u8bca\u540e\uff0c\u5728\u6cbb\u7597\u65f6\u95f4\u7a97\u5185\u5c3d\u65e9\u5f00\u901a\u6897\u585e\u76f8\u5173\u8840\u7ba1\u662f\u6539\u5584\u60a3\u8005\u9884\u540e\u6700\u5173\u952e\u7684\u6cbb\u7597\u3002\u65e0\u8bba\u662fACC \/ AHA \u8fd8\u662fESC \u7684STEMI \u7684\u6307\u5357\uff3b18\uff0c19\uff3d\uff0c\u65e9\u671f\u5f00\u901a\u6897\u585e\u76f8\u5173\u8840\u7ba1\u6cbb\u7597\u6240\u9700\u8981\u8003\u8651\u7684\u56e0\u7d20\u4e3b\u8981\u6709\u4ee5\u4e0b\u51e0\u4e2a\u65b9\u9762\uff1a\uff081\uff09\u662f\u5426\u5728\u6cbb\u7597\u65f6\u95f4\u7a97\u5185\uff1b\uff082\uff09\u60a3\u8005\u662f\u5426\u4ecd\u6709\u7f3a\u8840\u75c7\u72b6\uff1b\uff083\uff09\u60a3\u8005\u6709\u65e0\u5fc3\u8870\u8868\u73b0\uff1b\uff084\uff09\u6709\u65e0\u8840\u6d41\u52a8\u529b\u5b66\u4e0d\u7a33\u5b9a\u6216\u7535\u4e0d\u7a33\u5b9a\u8868\u73b0\uff1b\uff085\uff09\u8840\u8fd0\u91cd\u5efa\u6cbb\u7597\u7684\u98ce\u9669\u3002\u4e00\u822c\u60c5\u51b5\u8840\u8fd0\u91cd\u5efa\u5e94\u5728\u75c7\u72b6\u51fa\u73b012 h \u5185\u5c3d\u65e9\u8fdb\u884c\uff0c\u8981\u6c42\u4ece\u60a3\u8005\u5c31\u8bca\u81f3\u5f00\u59cb\u6eb6\u6813\u6cbb\u7597\u7684\u65f6\u95f4\uff08door-to-needle time\uff09\u4e0d\u8d85\u8fc730 min\uff0c\u4ece\u5c31\u8bca\u5230\u5f00\u901a\u6897\u585e\u76f8\u5173\u8840\u7ba1\u7684\u65f6\u95f4\uff08 doorto-balloon time\uff09\u4e0d\u8d85\u8fc790 min\u3002\u4f46\u662f\u867d\u7136\u8d85\u8fc712 h\uff0c\u5982\u679c\u60a3\u8005\u4ecd\u6709\u7f3a\u8840\u75c7\u72b6\uff0c\u6216\u8005\u5fc3\u529f\u80fdKillip \u5206\u7ea7\u2162\u7ea7\uff0c\u6216\u8005\u6709\u5fc3\u6e90\u6027\u4f11\u514b\u3001\u6301\u7eed\u6027\u5ba4\u901f\u7b49\u60c5\u51b5\u65f6\uff0c\u5219\u9700\u8981\u5c3d\u5feb\u8fdb\u884c\u8840\u8fd0\u91cd\u5efa\u6cbb\u7597\uff0c\u6b64\u65f6\u901a\u5e38\u9009\u62e9\u51a0\u72b6\u52a8\u8109\u9020\u5f71\u548c\u4ecb\u5165\u6cbb\u7597\u3002<\/p>\n\n\n\n

\u5bf9\u4e8e\u672a\u63a5\u53d7\u51a0\u8109\u9020\u5f71\u548c\u4ecb\u5165\u6cbb\u7597\u7684\u60a3\u8005\uff08 \u5305\u62ec\u672a\u63a5\u53d7\u4efb\u4f55\u8840\u8fd0\u91cd\u5efa\u6cbb\u7597\u548c\u4ec5\u63a5\u53d7\u9759\u8109\u6eb6\u6813\u6cbb\u7597\u7684\u60a3\u8005\uff09\uff0c\u5176\u51a0\u8109\u75c5\u53d8\u7684\u8303\u56f4\u53ca\u4e25\u91cd\u7a0b\u5ea6\u4e0d\u6e05\u695a\uff0c\u672a\u6765\u53d1\u751f\u4e25\u91cd\u5fc3\u810f\u4e8b\u4ef6\u7684\u98ce\u9669\u4e0d\u6e05\u695a\uff0c\u9700\u8981\u8fdb\u4e00\u6b65\u5371\u9669\u5206\u5c42\uff0c\u9009\u62e9\u9ad8\u5371\u7684\u60a3\u8005\u63a5\u53d7\u51a0\u72b6\u52a8\u8109\u9020\u5f71\u68c0\u67e5\uff0c\u5bf9\u4e8e\u5408\u9002\u7684\u75c5\u53d8\u8fdb\u884c\u4ecb\u5165\u6cbb\u7597\u6216\u642d\u6865\u624b\u672f\u3002\u7528\u4e8e\u5371\u9669\u5206\u5c42\u7684\u7b2c\u4e00\u4e2a\u5de5\u5177\u662f\u5de6\u5ba4\u5c04\u8840\u5206\u6570\uff08LVEF\uff09\uff0cACC \/ AHA \u6307\u5357\u5efa\u8bae\u6240\u6709LVEF < 40%\uff08ESC \u6307\u5357\u4e3a35%\uff09\u7684\u60a3\u8005\uff0c\u5747\u5e94\u63a5\u53d7\u51a0\u72b6\u52a8\u8109\u9020\u5f71\u3002LVEF\u226540%\u7684\u60a3\u8005\uff0c\u5219\u9700\u8981\u8fdb\u4e00\u6b65\u8fdb\u884c\u5371\u9669\u5206\u5c42\uff0c\u9ad8\u5371\u7684\u60a3\u8005\u9700\u8981\u63a5\u53d7\u51a0\u72b6\u52a8\u8109\u9020\u5f71\u3002\u6765\u6e90\u4e8e\u968f\u673a\u4e34\u5e8a\u8bd5\u9a8c\uff0c\u5927\u578b\u6ce8\u518c\u7814\u7a76\u7684\u6570\u636e\u5efa\u7acb\u4e86\u82e5\u5e72\u5371\u9669\u5206\u5c42\u65b9\u6cd5\uff0c\u5982TIMI \u5371\u9669\u79ef\u5206\uff08TIMI risk score\uff09\uff3b20\uff3d\u3001GUSTO \u4ee5\u53caPAMI\uff3b21\uff3d\u7b49\u3002TIMI \u5371\u9669\u79ef\u5206\u5c06\u4e0d\u540c\u7684\u5371\u9669\u56e0\u7d20\u8bbe\u4e3a\u4e0d\u540c\u7684\u6743\u91cd\uff0c\u5bf9\u60a3\u800530 d \u6b7b\u4ea1\u98ce\u9669\u8fdb\u884c\u8bc4\u4f30\u3002OR \u503c> 2. 5 \u8bb0\u4e3a3 \u5206\uff0cOR \u503c2. 0 \uff5e 2. 5 \u8bb0\u4e3a2\u5206\uff0c1. 0 \uff5e < 2. 0 \u8bb0\u4e3a1 \u5206\u30023 \u5206\u7684\u5371\u9669\u56e0\u7d20\u5305\u62ec\u5e74\u9f84\u8d85\u8fc775 \u5c81\uff0c\u6536\u7f29\u538b\u4f4e\u4e8e100 mm Hg\uff1b2 \u5206\u7684\u5371\u9669\u56e0\u7d20\u5305\u62ec\u5e74\u9f8465 \u523074 \u5c81\uff0c\u5fc3\u7387\u8d85\u8fc7100 \u6b21\/ min\uff0c\u5fc3\u529f\u80fdKillip\u5206\u7ea7\u2161\u81f3\u2163\u7ea7\uff1b1 \u5206\u7684\u5371\u9669\u56e0\u7d20\u5305\u62ec\u75c5\u53f2\uff08 \u9ad8\u8840\u538b\u75c5\u53f2\u3001\u7cd6\u5c3f\u75c5\u75c5\u53f2\u6216\u5fc3\u7ede\u75db\u53f2\uff09\uff0c\u4f53\u91cd\u4f4e\u4e8e67 kg\uff0c\u5f00\u59cb\u6eb6\u6813\u65f6\u95f4\u8d85\u8fc74 h\uff0c\u524d\u58c1\u5fc3\u808c\u6897\u6b7b\u6216\u5de6\u675f\u652f\u4f20\u5bfc\u963b\u6ede\u3002\u79ef\u52060 \u5206\u7684\u60a3\u800530 d \u6b7b\u4ea1\u7387\u4e3a0. 8%\uff0c1 \u5206\u4e3a1. 6%\uff0c2 \u5206\u4e3a2. 2%\uff0c3 \u5206\u4e3a4. 4%\uff0c4 \u5206\u4e3a7. 3%\uff0c5 \u5206\u4e3a12.4%\uff0c6 \u5206\u4e3a16. 1%\uff0c7 \u5206\u4e3a23. 4%\uff0c8 \u5206\u4e3a26. 8%\uff0c9 \u5206\u53ca\u4ee5\u4e0a\u4e3a35. 9%\u30022004 \u5e74\u53d1\u8868\u7684PAMI \u79ef\u5206\u65b9\u6cd5\u6765\u81ea\u4e8ePAMI \uff08Primary Angioplasty in Acute Myocardial Infarction\uff09\u7814\u7a76\u7684\u4eba\u7fa4\uff0c\u540c\u6837\u6839\u636eOR \u503c\u5c06\u4e0d\u540c\u7684\u5371\u9669\u56e0\u7d20\u8bbe\u4e3a\u4e0d\u540c\u7684\u6743\u91cd\u3002\u5e74\u9f84> 75 \u5c81\u8bb0\u4e3a7 \u5206\uff0c\u5e74\u9f8465 \uff5e75 \u5c81\u8bb0\u4e3a3 \u5206\uff0c\u5fc3\u529f\u80fdKillip \u5206\u7ea7\u2161 \uff5e\u2163\u7ea7\u8bb0\u4e3a2 \u5206\uff0c\u5fc3\u7387\u8d85\u8fc7100 \u6b21\/ min \u8bb0\u4e3a2 \u5206\uff0c\u7cd6\u5c3f\u75c5\u53f2\u8bb0\u4e3a2 \u5206\uff0c\u524d\u58c1\u5fc3\u808c\u6897\u6b7b\u6216\u5de6\u675f\u652f\u4f20\u5bfc\u963b\u6ede\u8bb0\u4e3a2 \u5206\u3002PAMI \u79ef\u5206\u503c\u5bf9\u51fa\u9662\u524d\u30011 \u4e2a\u6708\u30016 \u4e2a\u6708\u548c1 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STEMI \u6307\u5357\uff3b19\uff3d\u5efa\u8bae\u5982\u8d1f\u8377\u8bd5\u9a8c\u63d0\u793a\u5927\u8303\u56f4\u5fc3\u808c\u7f3a\u8840\uff08\u8d85\u8fc7\u5b58\u6d3b\u5fc3\u808c\u768450%\uff09\uff0c\u5219\u9700\u8981\u63a5\u53d7\u8fdb\u4e00\u6b65\u51a0\u72b6\u52a8\u8109\u9020\u5f71\u8bc4\u4ef7\u3002\u5bf9\u4e8e\u8303\u56f4\u8f83\u5c0f\u7684\u7f3a\u8840\u5fc3\u808c\uff08\u4e0d\u8d85\u8fc7\u5b58\u6d3b\u5fc3\u808c\u768420%\uff0c\u7279\u522b\u662f\u5728\u6897\u585e\u533a\u57df\u5185\u7684\uff09\u53ef\u9009\u62e9\u836f\u7269\u6cbb\u7597\u3002\u5bf9\u4e8e\u7f3a\u8840\u8303\u56f4\u4ecb\u4e8e\u4e8c\u8005\u4e4b\u95f4\u7684\u60a3\u8005\uff0c\u662f\u5426\u9700\u8981\u51a0\u8109\u9020\u5f71\u68c0\u67e5\u5219\u53d6\u51b3\u4e8e\u60a3\u8005\u7684\u75c7\u72b6\u3002\u7528\u5145\u5206\u7684\u836f\u7269\u6cbb\u7597\u4e0d\u80fd\u63a7\u5236\u5fc3\u7ede\u75db\u75c7\u72b6\u8005\uff0c\u9700\u8981\u63a5\u53d7\u51a0\u8109\u9020\u5f71\u68c0\u67e5\uff0c\u5e76\u5bf9\u5bfc\u81f4\u75c7\u72b6\u7684\u8840\u7ba1\u8fdb\u884c\u4ecb\u5165\u6cbb\u7597\u3002<\/p>\n\n\n\n

STEMI \u60a3\u8005\u8fd8\u5e94\u8bc4\u4f30\u56e0\u6076\u6027\u5fc3\u5f8b\u5931\u5e38\u731d\u6b7b\u7684\u98ce\u9669\u3002\u731d\u6b7b\u9ad8\u5371\u7684\u60a3\u8005\u9700\u690d\u5165ICD\u3002ACC \/ AHA 2004 \u5e74STEMI \u6307\u5357\uff3b18\uff3d\u5efa\u8bae\uff1a\u5982\u679c\u60a3\u8005\u6709\u81ea\u53d1\u7684\u5fc3\u5ba4\u98a4\u52a8\u6216\u53d1\u75c548 h \u540e\u4e0e\u77ed\u6682\u7f3a\u8840\u65e0\u5173\u7684\u5bfc\u81f4\u8840\u6d41\u52a8\u529b\u5b66\u4e0d\u7a33\u5b9a\u7684\u6301\u7eed\u6027\u5ba4\u901f\uff0c\u5219\u662f\u690d\u5165ICD \u7684\u2160\u7c7b\u9002\u5e94\u8bc1\uff08 \u8bc1\u636e\u7b49\u7ea7A\uff09\u3002\u5bf9\u4e8e\u65e0\u4e0a\u8ff0\u7279\u5f81\u7684\u5fc3\u808c\u6897\u6b7b\u60a3\u8005\u5219\u9700\u8981\u6839\u636e\u5de6\u5ba4\u5c04\u8840\u5206\u6570\u548c\u5fc3\u5185\u7535\u751f\u7406\u68c0\u67e5\u7684\u7ed3\u679c\u8bc4\u4f30\u60a3\u8005\u7684\u731d\u6b7b\u98ce\u9669\u8fdb\u884c\u5371\u9669\u5206\u5c42\u3002\u4ee5\u5fc3\u808c\u6897\u6b7b\u540e1 \u4e2a\u6708\u6216\u4ecb\u5165\u6cbb\u7597\u540e3 \u4e2a\u6708\u7684LVEF \u8fdb\u884c\u7b2c\u4e00\u6b21\u5371\u9669\u5206\u5c42\u3002LVEF\u226430%\u8005\u9700\u690d\u5165ICD\uff08\u2161a \u7c7b\u9002\u5e94\u8bc1\uff0c\u8bc1\u636e\u7b49\u7ea7B\uff09\uff0c\u800cLVEF > 40%\uff0c\u5219\u4e0d\u9700\u690d\u5165ICD\u3002\u5bf9\u4e8e\u4ecb\u4e8e\u4e8c\u8005\u4e4b\u95f4\u7684\uff0c\u5219\u9700\u8981\u6839\u636e\u5fc3\u7535\u7a33\u5b9a\u6027\u6216\u8fdb\u884c\u5fc3\u5185\u7535\u751f\u7406\u68c0\u67e5\u8fdb\u884c\u7b2c\u4e8c\u6b21\u5371\u9669\u5206\u5c42\u3002\u6709\u975e\u6301\u7eed\u6027\u5ba4\u901f\u7b49\u5fc3\u7535\u4e0d\u7a33\u5b9a\u8bc1\u636e\u5e76\u4e14\u7535\u751f\u7406\u68c0\u67e5\u8bf1\u53d1\u4e86\u5fc3\u5ba4\u98a4\u52a8\u6216\u6301\u7eed\u6027\u5ba4\u901f\u7684\u60a3\u8005\uff0c\u9700\u8981\u690d\u5165ICD\uff08\u2160\u7c7b\u9002\u5e94\u8bc1\uff0c\u8bc1\u636e\u7b49\u7ea7B\uff09\uff1b\u5bf9\u4e8e\u65e0\u5fc3\u7535\u4e0d\u7a33\u5b9a\u8bc1\u636e\u6216\u867d\u6709\u5fc3\u7535\u4e0d\u7a33\u5b9a\u8bc1\u636e\u4f46\u7535\u751f\u7406\u68c0\u67e5\u672a\u8bf1\u53d1\u5fc3\u5ba4\u98a4\u52a8\u6216\u6301\u7eed\u6027\u5ba4\u901f\u7684\u60a3\u8005\u690d\u5165ICD \u7684\u83b7\u76ca\u4e0d\u660e\u786e\uff0c\u4e3a\u2161b \u9002\u5e94\u8bc1\uff08\u8bc1\u636e\u7b49\u7ea7B\uff09\u3002<\/p>\n\n\n\n

\u7efc\u4e0a\u6240\u8ff0\uff0c\u65e0\u8bba\u662f\u6765\u6e90\u4e8e\u4e34\u5e8a\u8bd5\u9a8c\u3001\u6ce8\u518c\u7814\u7a76\uff0c\u8fd8\u662f\u6765\u6e90\u4e8e\u4e13\u4e1a\u5b66\u4f1a\u5236\u5b9a\u7684\u8bca\u7597\u6307\u5357\uff0c\u6240\u6709\u8fd9\u4e9b\u5371\u9669\u5206\u5c42\u65b9\u6cd5\u90fd\u6709\u5176\u4ea7\u751f\u7684\u7279\u6b8a\u80cc\u666f\uff0c\u6709\u5176\u7279\u5b9a\u7684\u9002\u7528\u4eba\u7fa4\u3002\u56e0\u6b64\u5728\u4e34\u5e8a\u5de5\u4f5c\u4e2d\u9700\u8981\u7ed3\u5408\u60a3\u8005\u7684\u5177\u4f53\u60c5\u51b5\u5bf9\u5176\u8fdb\u884c\u5371\u9669\u5206\u5c42\uff0c\u624d\u80fd\u5728\u5e94\u7528\u5faa\u8bc1\u533b\u5b66\u6210\u679c\u7684\u540c\u65f6\u5bf9\u60a3\u8005\u8fdb\u884c\u66f4\u4e3a\u4e2a\u4f53\u5316\u7684\u8bca\u6cbb\u3002\u5bf9\u4e8e\u8fd9\u4e9b\u5371\u9669\u5206\u5c42\u5de5\u5177\u7684\u638c\u63e1\uff0c\u66f4\u91cd\u8981\u7684\u5728\u4e8e\u9886\u4f1a\u5176\u601d\u60f3\uff0c\u7ed3\u5408\u4e2a\u4eba\u7684\u4e34\u5e8a\u7ecf\u9a8c\uff0c\u5f53\u65f6\u5f53\u5730\u53ef\u83b7\u5f97\u7684\u533b\u7597\u8d44\u6e90\uff0c\u5728\u4e34\u5e8a\u5de5\u4f5c\u4e2d\u4e0d\u65ad\u5b9e\u8df5\u63a2\u7d22\uff0c\u624d\u80fd\u65e2\u5145\u5206\u5e94\u7528\u76ee\u524d\u5148\u8fdb\u7684\u6cbb\u7597\u624b\u6bb5\uff0c\u53c8\u4e0d\u589e\u52a0\u6cbb\u7597\u76f8\u5173\u7684\u98ce\u9669\uff0c\u5e76\u5c3d\u53ef\u80fd\u8282\u7ea6\u533b\u7597\u8d44\u6e90\uff0c\u83b7\u5f97\u6700\u4f73\u7684\u98ce\u9669\/ \u83b7\u76ca\u6bd4\u548c\u8d39\u7528\/ \u83b7\u76ca\u6bd4\u3002<\/p>\n\n\n\n

\uff3b \u53c2\u8003\u6587\u732e\uff3d<\/p>\n\n\n\n

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\uff3b21\uff3d Addala S\uff0cGrines CL\uff0cDixon SR\uff0cet al. Predicting mortality in patients with STelevation myocardial infarction treated with primary percutaneous coronary intervention\uff08<\/p>\n\n\n\n

PAMI risk score\uff09\uff3bJ\uff3d. Am J Cardiol\uff0c2004\uff0c93\uff1a629-632.<\/p>\n","protected":false},"excerpt":{"rendered":"

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