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截至 2 0 0 2年 7月 ,急性心肌梗塞 (acutemyocardialinfarction ,AMI)治疗的临床证据如下 :(1 )改善AMI预后的证据 :①血管紧张素转换酶抑制剂 (ACEI) :1篇概述和 1个 (AMI 36h到 1 4d内接受治疗的患者 )系统评价发现 ,血管紧张素转换酶抑制剂和安慰剂相比 ,患者 30d后的死亡率明显减少 ;血管紧张素转换酶抑制剂和安慰剂相比 ,显著增加了持续低血压和肾功能不全。血管紧张素转换酶抑制剂是提供给每一位存在AMI的患者 ,还是仅提供给有心衰征象的患者 ,目前尚无定论。②阿司匹林 :1个系统评价发现 ,阿司匹林与安慰剂相比 ,能明显减少 1个月时的死亡率、非致死性再梗塞以及非致死性中风。③ β受体阻滞剂 :2个系统评价和 1个后来的RCT发现 ,在AMI数小时内给予 β受体阻滞剂与对照比较 ,显著减少死亡率和再梗塞率。溶栓治疗的RCT发现 ,美托洛尔的及时使用与延后使用相比 ,明显减少患者 6d后再梗塞率以及复发的胸痛 ,但使用该药 6d和 1年间的死亡率没有显著差异。 1个研究比较了在近期有心肌梗塞并且左室射血分数小于 4 0 % ,或者基本没有接受溶栓治疗的患者中使用卡维地洛与安慰剂的RCT发现 ,尽管单独的死亡率和复发性非致死性AMI在卡维地洛组中明显较低 ,但 1 3年后各种原因的死亡率以及由于心血管事件住
As of July 2002, the clinical evidence for the treatment of acute myocardial infarction (AMI) is as follows: (1) Evidence to improve the prognosis of AMI: ① Angiotensin-converting enzyme inhibitor (ACEI): 1 summary and 1 (AMI patients treated within 36h to 14d) A systematic review found that patients treated with angiotensin converting enzyme inhibitors had a significantly reduced mortality after 30 days compared with placebo; angiotensin converting enzyme inhibitors compared with placebo , Significantly increased persistent hypotension and renal insufficiency. Angiotensin converting enzyme inhibitors are provided to every patient with AMI, or only to patients with heart failure, is currently inconclusive. ② Aspirin: A systematic review found that aspirin significantly reduced mortality at 1 month, nonfatal reinfarction, and non-fatal stroke compared with placebo. ③ β blockers: Two systematic reviews and one subsequent RCT found that administration of beta blockers within hours of AMI significantly reduced mortality and reinfarction compared with controls. The thrombolytic RCT found that the prompt use of metoprolol significantly reduced the rate of reinfarction 6 days and recurrence of chest pain in patients treated with delayed use, but there was no significant difference in the 6-and 1-year mortality with metoprolol. One study compared RCTs using carvedilol with placebo in patients who had recent myocardial infarction with a left ventricular ejection fraction of less than 40%, or who had essentially no thrombolytic therapy, despite separate mortality and relapse Non-fatal AMI was significantly lower in the carvedilol group, but mortality rates for various causes after 13 years and mortality due to cardiovascular events