Kiowski W
Departement für Innere Medizin, Universitätskliniken, Kantonsspital Basel.
Schweiz Med Wochenschr. 1990 Oct 20;120(42):1531-8.
Rapid reestablishment of myocardial blood supply is the ideal in the treatment of acute myocardial infarction. Thrombolysis and, in selected cases, percutaneous transluminal coronary angioplasty (PTCA) or coronary bypass surgery may limit the extent of myocardial necrosis and improve survival. An open, infarct-related artery after thrombolysis carries a better prognosis, but it remains to be established whether the persistent lesion needs to be treated by PCTA or surgery in all patients. Early intravenous beta blockade reduces inhospital mortality by approximately 15% in patients without thrombolysis, while calcium antagonists, despite their theoretical promise and in vitro results, are not effective in the early phase of acute myocardial infarction. Only diltiazem seems to reduce the incidence of reinfarction in patients with non-Q-wave infarction. Aspirin reduces mortality in patients with unstable angina pectoris and in patients with acute myocardial infarction with or without concomitant thrombolysis.
迅速重建心肌血液供应是急性心肌梗死治疗的理想目标。溶栓治疗以及在特定病例中进行的经皮腔内冠状动脉成形术（PTCA）或冠状动脉搭桥手术，可能会限制心肌坏死的范围并提高生存率。溶栓后梗死相关动脉开通预示着较好的预后，但对于所有患者，持续性病变是否均需通过PTCA或手术治疗仍有待确定。在未接受溶栓治疗的患者中，早期静脉应用β受体阻滞剂可使住院死亡率降低约15%，而钙拮抗剂尽管在理论上有前景且体外实验有效果，但在急性心肌梗死早期并无疗效。仅地尔硫䓬似乎可降低非Q波梗死患者的再梗死发生率。阿司匹林可降低不稳定型心绞痛患者以及接受或未接受溶栓治疗的急性心肌梗死患者的死亡率。
