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.
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.
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。
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