Raos Vjekoslava, Raguz Miroslav, Rajcan Spoljarić Ivana, Vrazić Hrvoje, Culo Melanie-Ivana, Bergovec Mijo
University Department of Medicine, Dubrava University Hospital, Zagreb, Croatia.
Acta Med Croatica. 2009 Feb;63(1):53-8.
The objective of prehospital care of patients with acute coronary syndrom (ACS) [acute ST segment elevation myocardial infarction (STEMI), acute non-ST segment elevation myocardial infarction (NSTEMI), and unstable angina (UA)], is prompt diagnosis of the acute myocardial infarction, patient's risk assessment, drug administration in order to reduce patient's pain and fear, and prevention or treatment of heart failure. In hospital treatment therapeutic procedures include reperfusion therapy, limitation of infarction zone, treatment of complications (heart failure, life-threatening arrhythmias), prevention of reinfarction, heart failure and eventually prevention of sudden cardiac death. Acute therapeutic procedures include revascularization, anti-ischemic and antithrombolytic treatment, possible surgical revascularization and treatment of complications (arrhythmias, heart failure). The patients with STEMI that present within 3-12 hours from the onset of chest pain should undergo primary percutaneous coronary intervention (PCI). In case of presentation within 3 hours from the occurrence of chest pain, the administration of thrombolytic therapy in this period is equally efficient as PCI. Regardless of reperfusion regimen, the anti-ischemics administered including nitrates (nitroglycerin); intravenous analgesics (morphine-sulfate); O2 2-4 L/min; beta-adrenergic blockers; calcium channel blockers; angiotensin converting enzyme inhibitors (ACE-I); magnesium and glucose-insulin-potassium have proved to be efficient as shown by study results and clinical experience. The mechanism of action of anti-ischemics includes reduction in myocardial oxygen consumption achieved by a decrease of heart frequency, reduction of systemic blood pressure and reduction in myocardial contractility by vasodilatation and consequent better myocardial oxygen supply. The outstanding results of major clinical studies are presented, and main guidelines for anti-ischemic therapy of ACS adopted by the international professional associations are set forth.
急性冠状动脉综合征（ACS）[急性ST段抬高型心肌梗死（STEMI）、急性非ST段抬高型心肌梗死（NSTEMI）和不稳定型心绞痛（UA）]患者的院前护理目标是迅速诊断急性心肌梗死、评估患者风险、给药以减轻患者疼痛和恐惧，以及预防或治疗心力衰竭。住院治疗的治疗程序包括再灌注治疗、限制梗死区域、治疗并发症（心力衰竭、危及生命的心律失常）、预防再梗死、心力衰竭并最终预防心源性猝死。急性治疗程序包括血管重建、抗缺血和抗血栓治疗、可能的外科血管重建以及并发症（心律失常、心力衰竭）的治疗。胸痛发作后3至12小时内就诊的STEMI患者应接受直接经皮冠状动脉介入治疗（PCI）。如果在胸痛发作后3小时内就诊，在此期间给予溶栓治疗与PCI同样有效。无论采用何种再灌注方案，包括硝酸盐（硝酸甘油）、静脉镇痛药（硫酸吗啡）、2-4L/min的氧气、β-肾上腺素能阻滞剂、钙通道阻滞剂、血管紧张素转换酶抑制剂（ACE-I）、镁和葡萄糖-胰岛素-钾在内的抗缺血药物已被研究结果和临床经验证明是有效的。抗缺血药物的作用机制包括通过降低心率、降低体循环血压以及通过血管扩张降低心肌收缩力来减少心肌耗氧量，从而改善心肌氧供。文中介绍了主要临床研究的显著成果，并阐述了国际专业协会采用的ACS抗缺血治疗的主要指南。
