重症监护病房中的心肌梗死：诊断与治疗的系统评价
Myocardial infarction in intensive care units: A systematic review of diagnosis and treatment.
作者信息
Carroll Iain, Mount Thomas, Atkinson Dougal
机构信息
Adult Critical Care Unit, Royal London Hospital, London, UK.
Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
出版信息
J Intensive Care Soc. 2016 Nov;17(4):314-325. doi: 10.1177/1751143716656642. Epub 2016 Jul 1.
Abstract
INTRODUCTION
Patients in the intensive care unit are vulnerable to myocardial injury from a variety of causes, both ischaemic and non-ischaemic. It is challenging for ICU clinicians to apply the conventional guidance concerning diagnosis and treatment. We conducted this review to examine the evidence concerning diagnosis and treatment of myocardial infarction in the ICU.
METHODS
A systematic review was performed to identify relevant studies.
RESULTS
19 studies concerning use of ECG, cardiac enzymes, echocardiography and angiography were identified. 4 studies considered treatment of myocardial infarction.
CONCLUSIONS
Regular 12 lead ECG or 12 lead ECG monitoring is more sensitive than 2 lead monitoring, regular measurement of cardiac enzymes is more sensitive than when provoked by symptoms. Coronary angiography rarely identifies treatable lesions, without regional wall motion abnormality on echocardiography. Evidence relating to treatment was limited. A potential strategy to diagnose myocardial infarctions in the ICU is proposed.
摘要
引言
重症监护病房的患者易因多种原因发生心肌损伤，包括缺血性和非缺血性原因。对于重症监护病房的临床医生而言，应用传统的诊断和治疗指南具有挑战性。我们进行了这项综述，以研究重症监护病房中心肌梗死诊断和治疗的相关证据。
方法
进行了一项系统综述以识别相关研究。
结果
确定了19项关于使用心电图、心肌酶、超声心动图和血管造影的研究。4项研究考虑了心肌梗死的治疗。
结论
常规12导联心电图或12导联心电图监测比2导联监测更敏感，定期测量心肌酶比症状激发时测量更敏感。在超声心动图无节段性室壁运动异常的情况下，冠状动脉造影很少能发现可治疗的病变。与治疗相关的证据有限。提出了一种在重症监护病房诊断心肌梗死的潜在策略。
相似文献
1
Myocardial infarction in intensive care units: A systematic review of diagnosis and treatment.重症监护病房中的心肌梗死：诊断与治疗的系统评价
J Intensive Care Soc. 2016 Nov;17(4):314-325. doi: 10.1177/1751143716656642. Epub 2016 Jul 1.
2
Elevated troponin and myocardial infarction in the intensive care unit: a prospective study.重症监护病房中肌钙蛋白升高与心肌梗死：一项前瞻性研究。
Crit Care. 2005;9(6):R636-44. doi: 10.1186/cc3816. Epub 2005 Sep 28.
3
Detecting myocardial infarction in critical illness using screening troponin measurements and ECG recordings.利用肌钙蛋白筛查检测和心电图记录来诊断危重症患者的心肌梗死。
Crit Care. 2008;12(2):R36. doi: 10.1186/cc6815. Epub 2008 Mar 4.
4
Feasibility of prehospital identification of non-ST-elevation myocardial infarction by ECG, troponin and echocardiography.心电图、肌钙蛋白和超声心动图在院前识别非 ST 段抬高型心肌梗死的可行性。
Emerg Med J. 2022 Sep;39(9):679-684. doi: 10.1136/emermed-2021-211179. Epub 2022 Jan 21.
5
Prognostic importance of postbypass regional wall-motion abnormalities in patients undergoing coronary artery bypass graft surgery. SPI Research Group.冠状动脉旁路移植手术患者体外循环后局部室壁运动异常的预后重要性。SPI研究小组。
Anesthesiology. 1989 Jul;71(1):16-25. doi: 10.1097/00000542-198907000-00004.
6
The concordance of intraoperative left ventricular wall-motion abnormalities and electrocardiographic S-T segment changes: association with outcome after coronary revascularization. Multicenter Study of Perioperative Ischemia (McSPI) Research Group.术中左心室壁运动异常与心电图ST段改变的一致性：与冠状动脉血运重建术后结局的关联。围手术期缺血多中心研究（McSPI）研究组。
Anesthesiology. 1998 Apr;88(4):945-54. doi: 10.1097/00000542-199804000-00014.
7
Diagnostic and prognostic value of dipyridamole echocardiography in patients with suspected coronary artery disease. Comparison with exercise electrocardiography.双嘧达莫超声心动图对疑似冠心病患者的诊断和预后价值。与运动心电图的比较。
Circulation. 1994 Mar;89(3):1160-73. doi: 10.1161/01.cir.89.3.1160.
8
Diagnostic application of the universal definition of myocardial infarction in the intensive care unit.心肌梗死通用定义在重症监护病房的诊断应用
Curr Opin Crit Care. 2008 Oct;14(5):543-8. doi: 10.1097/MCC.0b013e32830d34b9.
9
Systematic review of the effectiveness and cost-effectiveness, and economic evaluation, of myocardial perfusion scintigraphy for the diagnosis and management of angina and myocardial infarction.心肌灌注闪烁扫描术用于心绞痛和心肌梗死诊断与管理的有效性、成本效益及经济评估的系统评价
Health Technol Assess. 2004 Jul;8(30):iii-iv, 1-207. doi: 10.3310/hta8300.
10
Unplanned transfer from the telemetry unit to the intensive care unit in hospitalized patients with suspected acute coronary syndrome.疑似急性冠状动脉综合征住院患者从遥测病房意外转至重症监护病房。
J Electrocardiol. 2016 Nov-Dec;49(6):775-783. doi: 10.1016/j.jelectrocard.2016.08.010. Epub 2016 Aug 26.
引用本文的文献
1
Defensive Medicine in an Emergency Department: The Overuse of High-Sensitivity Cardiac Troponin I Testing.急诊科的防御性医疗：高敏肌钙蛋白I检测的过度使用
Life (Basel). 2024 Nov 28;14(12):1563. doi: 10.3390/life14121563.
2
Dexmedetomidine administration is associated with improved outcomes in critically ill patients with acute myocardial infarction partly through its anti-inflammatory activity.右美托咪定给药与急性心肌梗死重症患者预后改善相关，部分原因是其具有抗炎活性。
Front Pharmacol. 2024 Aug 22;15:1428210. doi: 10.3389/fphar.2024.1428210. eCollection 2024.
3
Thiamine administration may increase survival benefit in critically ill patients with myocardial infarction.给予硫胺素可能会增加心肌梗死重症患者的生存获益。
Front Nutr. 2023 Aug 29;10:1227974. doi: 10.3389/fnut.2023.1227974. eCollection 2023.
4
Elevated Cardiac Troponin Is Most Often Associated With Type 2 Myocardial Infarction in Trauma Patients.心肌肌钙蛋白升高在创伤患者中最常与2型心肌梗死相关。
Cureus. 2023 May 30;15(5):e39711. doi: 10.7759/cureus.39711. eCollection 2023 May.
5
Assessment of Oxygen Supply-Demand Imbalance and Outcomes Among Patients With Type 2 Myocardial Infarction: A Secondary Analysis of the High-STEACS Cluster Randomized Clinical Trial.2 型心肌梗死患者的氧供需失衡评估及结局：高 STEACS 聚类随机临床试验的二次分析。
JAMA Netw Open. 2022 Jul 1;5(7):e2220162. doi: 10.1001/jamanetworkopen.2022.20162.
6
[Diagnosis of myocardial infarction in critically ill, ventilated patients].[危重症机械通气患者心肌梗死的诊断]
Med Klin Intensivmed Notfmed. 2019 May;114(4):290-296. doi: 10.1007/s00063-019-0572-9. Epub 2019 Mar 28.
7
The safety and efficacy of nicotine replacement therapy in the intensive care unit: a randomised controlled pilot study.重症监护病房中尼古丁替代疗法的安全性和有效性：一项随机对照试验性研究。
Ann Intensive Care. 2018 Jun 7;8(1):70. doi: 10.1186/s13613-018-0399-1.
本文引用的文献
1
Coronary artery disease in patients clinically diagnosed with myocardial infarction in the medical intensive care unit.在医疗重症监护病房中，临床上诊断为心肌梗死的患者中的冠状动脉疾病。
J Crit Care. 2013 Aug;28(4):532.e11-7. doi: 10.1016/j.jcrc.2013.01.001. Epub 2013 Feb 18.
2
ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.ST段抬高型急性心肌梗死患者管理的欧洲心脏病学会指南
Eur Heart J. 2012 Oct;33(20):2569-619. doi: 10.1093/eurheartj/ehs215. Epub 2012 Aug 24.
3
Third universal definition of myocardial infarction.心肌梗死的第三次全球定义。
Eur Heart J. 2012 Oct;33(20):2551-67. doi: 10.1093/eurheartj/ehs184. Epub 2012 Aug 24.
4
Troponin in critically ill patients.危重症患者中的肌钙蛋白。
Minerva Anestesiol. 2012 Sep;78(9):1039-45. Epub 2012 Jun 20.
5
Acute myocardial infarction in non-cardiac critically ill patients: a clinical-pathological study.非心脏重症患者的急性心肌梗死：一项临床病理研究。
Monaldi Arch Chest Dis. 2010 Dec;74(4):164-71. doi: 10.4081/monaldi.2010.257.
6
Electrocardiographic ST-segment elevation myocardial infarction in critically ill patients: an observational cohort analysis.危重症患者心电图 ST 段抬高型心肌梗死：一项观察性队列分析。
Crit Care Med. 2010 Dec;38(12):2304-9. doi: 10.1097/CCM.0b013e3181fa02cd.
7
The Global Registry of Acute Coronary Events, 1999 to 2009--GRACE.全球急性冠脉事件注册研究 1999 年至 2009 年——GRACE。
Heart. 2010 Jul;96(14):1095-101. doi: 10.1136/hrt.2009.190827. Epub 2010 May 29.
8
Etiology of troponin elevation in critically ill patients.危重症患者肌钙蛋白升高的病因。
J Crit Care. 2010 Jun;25(2):322-8. doi: 10.1016/j.jcrc.2009.07.002. Epub 2009 Sep 24.
9
The diagnosis of myocardial infarction in critically ill patients: an agreement study.危重症患者心肌梗死的诊断：一项一致性研究。
J Crit Care. 2009 Sep;24(3):447-52. doi: 10.1016/j.jcrc.2008.08.012. Epub 2009 Jan 17.
10
Diagnostic application of the universal definition of myocardial infarction in the intensive care unit.心肌梗死通用定义在重症监护病房的诊断应用
Curr Opin Crit Care. 2008 Oct;14(5):543-8. doi: 10.1097/MCC.0b013e32830d34b9.
Zotero 插件