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                          2. 您当前所在位置:2978棋牌 > PPT课件 > 课件PPT → 心梗介入治疗及护理PPT

                            心梗介入治疗及护理PPT

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                            心梗介入治疗及护理PPT2978棋牌

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                            ZHEISHIXINGENGJIERUZHILIAOJIHULIPPTXIAZAI,ZHUYAOJIESHAOLEXINGENGZHILIAO--RONGSHUANYUJIERUDUIBI,RONGSHUANYUJIERUDEBIJIAO,QIANGDIAO“ZONGQUEXUESHIJIAN”DEGAINIAN,YIJINKUAIKAITONGZUIFANXUEGUAN2019 ZHINAN,ZHIJIEPCIDEXIANZHUANG,XUANZEYIJU,RONGSHUANHOULIJIHUOQUEXUEQUDONGPCIHUICUI,HUANYINGDIANJIXIAZAIE。

                            心肌梗死的药物介入策略 历史,现状与展望 时间就是心肌,就是生命 90年代中已证明溶栓治疗的益处 与安慰剂对比 答案是肯定的 溶栓仍有必要: 因为快 溶栓仍有市场: 因为PPCI不可能完全占领 溶栓仍有地位:因为效果未必差于PPCI 溶栓与PPCI如何选择? 溶栓与PCI完全能够结合 总缺血时间:每一分钟都有意义 溶栓与介入的比较 NRMI-2: 死亡率与时间的关系 2019ACC/AHA AMI指南的选择的推荐 下列情形下溶栓更好 到院很早(≤3h)介入可能延迟 介入不可选 导管室没空 血管入路有困难 没有熟练的医生 介入延迟 (Door-balloon)-(Door-needle)>1h Medical contact-balloon time>1.5h 下列情形下介入更好 熟练的队伍且有外科保障 (Door-balloon)-(Door-needle)<1h Medical contact-balloon time<1.5h 髙危患者 心源性休克或Killip≥3级 溶栓有禁忌或可能增加出血危险 到院太迟,症状发作>3h 诊断STEMI有疑问 强调“总缺血时间”的概念,以尽快开通罪犯血管2019 指南 总缺血时间 答案是肯定的 溶栓仍有必要: 因为快 溶栓仍有市场: 因为PPCI不可能完全占领 溶栓仍有地位:因为效果未必差于PPCI 溶栓与PPCI如何选择? 溶栓与PCI完全能够结合 我们的国情 人口众多 医疗资源分布不均 地理条件差异 平均 D2B>180min 实际STEMI溶栓率>55% 一定有患者需要溶栓 一定有更适合溶栓的患者,即使在可PCI的医院 溶栓不是治疗的终点 直接PCI的现状 按50人/10万人口算 全国每年STEMI 60万例,直接PCI 2.5万例(保守估算) 北京D2B<90min 仅19% 美国D2B<90min 也仅35% 答案是肯定的 溶栓仍有必要: 因为快 溶栓仍有市场: 因为PPCI不可能完全占领 溶栓仍有地位:因为效果未必差于PPCI 溶栓与PPCI如何选择? 溶栓与PCI完全能够结合 Fast-MI 研究发现: 其实溶栓未必差于PPCI 答案是肯定的 溶栓仍有必要: 因为快 溶栓仍有市场: 因为PPCI不可能完全占领 溶栓仍有地位:因为效果未必差于PPCI 溶栓与PPCI如何选择? 溶栓与PCI完全能够结合 选择依据1---起病长短 选择依据2---拖延时间 NRMI资料 选择依据3---患者本身风险 DANAMI-2发现转运PCI有益于高危者 选择依据4 年龄,梗死部位,就诊时间 答案是肯定的 溶栓仍有必要: 因为快 溶栓仍有市场: 因为PPCI不可能完全占领 溶栓仍有地位:因为效果未必差于PPCI 溶栓与PPCI如何选择? 溶栓与PCI完全能够结合 Immediate PCI Immediate PCI---no good Immediate PCI? 80-90’s data suggest harmful lytic activated platelet,more thrombogenic Prone to hemorragic in intracoronary lesion More vascular complications Aspirin not given with thrombolysis Low dose heparine,noACT monitor GP IIb/IIIa antagonist & Thienopydine not used Stent not available ACC/AHA2019 AMI Guideline described early angiogram after successful lytic Routine ,Immediately after lytic Tx ClassIII Following successful lytic Tx in Asx Pts without ischemia Class IIb ACC/AHA2019 PCIGuideline described early angiogram after successful lytic 06 ESC AMI guideline :OK Key trials for immediate PCI OK CAPITAL further support routine PCI after lysis 07 further meta-analysis: new evidence of PCI reasonable after lysis 溶栓后立即或缺血驱动PCI荟萃 为什么又行了? 介入的发展:支架、IIb/IIIa 溶栓药的发展:短效溶栓药 介入的时机选对了 Rescue PCI—early Rescue PCI(GUSTO-1) GUSTO-1---不补救更好 Key trial for rescue PCI Meta analysis of Rescue PCI2019 PACT PACT CAPTIM Trial arouse some hope Key trials for facilitate PCI FINESSE PCI前常规abciximab或PCI时嘱情abciximab的比较 不管是否有半量瑞替普酶溶栓 结果一样且院前应用Ab出血增多 Finesse:PCI前Ab无益处 Meta analysis for F-PCI prePCI TIMI flow not transfer to good outcome Meta analysis for F-PCI Facilitate PCI 2019 guideline 转运是安全的 易化,立即,转运的综合 转运与立即PCI的结合 转运与立即PCI的结合: Sx<2hTNK 溶栓后PCI Meta2019 溶栓后PCI获益 溶栓后PCI Meta-2019 溶栓后PCI Meta-2019 Background :Current ESC Guideline 尚待回答的问题 Is routine PCI after TT safe? (bleeding? Ischemia?)---ASSENT4 Are all lytic agent suitable for TT in this strategy? When is the suitable or optimal time of PCI after TT Time intervals Clinical outcomes at 30days after symptom onset (n=47) TMPFC: A novel method for myocardium perfusion assessment Conclusion from pilot Rt-PA 50mg reached 76% successful rate(>=TIMI2) and is suitable for pharmacoinvasive PCI can be safely performed after rt-PA thrombolysis without increasing bleeding and other complications PCI after rt-PA will further increase epicardial as well as myocardial reperfusion. Although the time window of PCI after lytic still need further elucidated ,our primary results showing that 3-6 hrs is good for reperfusion,epicardial or myocardium. Perspective from pilot Whether epicardial and myocardial reperfusion benefit transfer to clinical endpoint benefit need further study. It’s time to further elucidate whether this pharmacoinvasive strategy is comparable with primary PCI. Larger scale of trial is going to start. Evaluate the Efficacy and Safety of AF-PCI vs. Primary PCI on Epicardial and Myocardial Reperfusion Rate in Patient with Acute STEMI Primary Endpoint ► Complete Epicardial + Myocardial Reperfusion TIMI 3 (for Epicardial Reperfusion)+ TMPG 3 +STR≥ 70% for Myocardial Reperfusion Secondary Endpoints ► TMPFC- a continous index assessing Myocardial Reperfusion ► CTFC - a continous index assessing Epicardial Reperfusion ► Infarct size assessment by AUC of CK-MB and TnT ► MACE (death, reinfarction, TVR, stroke) in-hospital & 30 days after randomization Take Home Message 溶栓仍有地位 溶栓与PCI完全可以结合,不是也不该对立 溶栓后PCI安全有效 溶栓后PCI目前指南尚不完善,最佳时间点仍有待探索

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                            急性心梗护理ppt:这是急性心梗护理ppt下载,主要介绍了病因和发病机制;临床表现;实验室和其他检查;并发症;治疗;预防预后;保健指导,欢迎点击下载。
                            右室心梗治疗PPT:这是右室心梗治疗PPT下载,主要介绍了概述;右室的血供来源;右室梗死病理生理;临床表现;心电图特征;治疗,欢迎点击下载。
                            心梗ppt:这是心梗ppt下载,心肌梗塞的临床表现;心绞痛与心机梗死的鉴别要点;心肌梗塞的实验室检查;心肌梗塞的护理常规,欢迎点击下载哦。
                            《心梗介入治疗及护理PPT》是由用户yangminling于2019-03-22上传,属于课件PPT。

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