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美国UA/NSTEMI指南解读

2011-08-17 MedSci原创 MedSci原创

心肌梗死心绞痛
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　　2011年8月11日，在中国心脏大会的冠心病热点论坛上，首都医科大学附属北京安贞医院的周志明教授点评了2011美国不稳定心绞痛和非ST段抬高心肌梗死（UA/NSTEMI）指南更新中备受关注的几个问题。 　　对于有胃肠道出血史的UA/NSTEMI患者，进行抗血小板治疗时，是否应该加用质子泵抑制剂（PPI）？更新的指南删除了加用PPI的推荐。 　　对于UA/NSTEMI中的高危患者，如果选择有

　　2011年8月11日，在中国心脏大会的冠心病热点论坛上，首都医科大学附属北京安贞医院的周志明教授点评了2011美国不稳定心绞痛和非ST段抬高心肌梗死（UA/NSTEMI）指南更新中备受关注的几个问题。

　　对于有胃肠道出血史的UA/NSTEMI患者，进行抗血小板治疗时，是否应该加用质子泵抑制剂（PPI）？更新的指南删除了加用PPI的推荐。

　　对于UA/NSTEMI中的高危患者，如果选择有创策略，应怎样制定抗血小板治疗方案？指南推荐双联抗血小板治疗，使用阿司匹林+氯吡格雷（普拉格雷）或者阿司匹林+糖蛋白Ⅱb/Ⅲa抑制剂。

　　拟实施PCI的UA/NSTEMI患者，如何正确给予抗血小板药物的负荷量及维持量？对此，新的推荐与2009年一致，推荐使用噻吩并吡啶，负荷量使用氯吡格雷300 mg或者普拉格雷60 mg，维持量为氯吡格雷75 mg或普拉格雷10 mg至少12个月。如果出血风险大于获益，应考虑早期结束噻吩并吡啶治疗。

　　在更新的指南中，普拉格雷在抗血小板药物中的地位得到提升。另外，拟行PCI的患者，需要把握抗血小板治疗的尺度。风险低的患者不推荐三联抗血小板治疗。PCI术后抗血小板治疗的剂量与疗程需要全面权衡利弊。

　　在抗血小板治疗之外，对于保守与介入治疗策略、合并慢性肾病患者的策略以及血小板功能测定的意义，指南都有相应的更新。

　

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    2012-04-08 drj2003

    #NST#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1977473, encodeId=247019e747373, content=<a href='/topic/show?id=d9e5130962f' target=_blank style='color:#2F92EE;'>#NST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13096, encryptionId=d9e5130962f, topicName=NST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80c5136, createdName=drj2003, createdTime=Sun Apr 08 21:52:00 CST 2012, time=2012-04-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1481767, encodeId=78011481e67d0, content=<a href='/topic/show?id=8cc416e78f3' target=_blank style='color:#2F92EE;'>#STEM#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16778, encryptionId=8cc416e78f3, topicName=STEM)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d1067833268, createdName=12498bb3m92(暂无昵称), createdTime=Fri Aug 19 12:52:00 CST 2011, time=2011-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1500919, encodeId=6b45150091998, content=<a href='/topic/show?id=3cad13104d5' target=_blank style='color:#2F92EE;'>#NSTEMI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13104, encryptionId=3cad13104d5, topicName=NSTEMI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e5bc9475211, createdName=wleon8898, createdTime=Fri Aug 19 12:52:00 CST 2011, time=2011-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1551712, encodeId=3ad01551e126e, content=<a href='/topic/show?id=305156401eb' target=_blank style='color:#2F92EE;'>#指南解读#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56401, encryptionId=305156401eb, topicName=指南解读)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=eb0214221999, createdName=shuangle, createdTime=Fri Aug 19 12:52:00 CST 2011, time=2011-08-19, status=1, ipAttribution=)]
    2011-08-19 12498bb3m92(暂无昵称)

    #STEM#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1977473, encodeId=247019e747373, content=<a href='/topic/show?id=d9e5130962f' target=_blank style='color:#2F92EE;'>#NST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13096, encryptionId=d9e5130962f, topicName=NST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80c5136, createdName=drj2003, createdTime=Sun Apr 08 21:52:00 CST 2012, time=2012-04-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1481767, encodeId=78011481e67d0, content=<a href='/topic/show?id=8cc416e78f3' target=_blank style='color:#2F92EE;'>#STEM#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16778, encryptionId=8cc416e78f3, topicName=STEM)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d1067833268, createdName=12498bb3m92(暂无昵称), createdTime=Fri Aug 19 12:52:00 CST 2011, time=2011-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1500919, encodeId=6b45150091998, content=<a href='/topic/show?id=3cad13104d5' target=_blank style='color:#2F92EE;'>#NSTEMI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13104, encryptionId=3cad13104d5, topicName=NSTEMI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e5bc9475211, createdName=wleon8898, createdTime=Fri Aug 19 12:52:00 CST 2011, time=2011-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1551712, encodeId=3ad01551e126e, content=<a href='/topic/show?id=305156401eb' target=_blank style='color:#2F92EE;'>#指南解读#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56401, encryptionId=305156401eb, topicName=指南解读)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=eb0214221999, createdName=shuangle, createdTime=Fri Aug 19 12:52:00 CST 2011, time=2011-08-19, status=1, ipAttribution=)]
    2011-08-19 wleon8898

    #NSTEMI#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1977473, encodeId=247019e747373, content=<a href='/topic/show?id=d9e5130962f' target=_blank style='color:#2F92EE;'>#NST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13096, encryptionId=d9e5130962f, topicName=NST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80c5136, createdName=drj2003, createdTime=Sun Apr 08 21:52:00 CST 2012, time=2012-04-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1481767, encodeId=78011481e67d0, content=<a href='/topic/show?id=8cc416e78f3' target=_blank style='color:#2F92EE;'>#STEM#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16778, encryptionId=8cc416e78f3, topicName=STEM)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d1067833268, createdName=12498bb3m92(暂无昵称), createdTime=Fri Aug 19 12:52:00 CST 2011, time=2011-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1500919, encodeId=6b45150091998, content=<a href='/topic/show?id=3cad13104d5' target=_blank style='color:#2F92EE;'>#NSTEMI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13104, encryptionId=3cad13104d5, topicName=NSTEMI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e5bc9475211, createdName=wleon8898, createdTime=Fri Aug 19 12:52:00 CST 2011, time=2011-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1551712, encodeId=3ad01551e126e, content=<a href='/topic/show?id=305156401eb' target=_blank style='color:#2F92EE;'>#指南解读#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56401, encryptionId=305156401eb, topicName=指南解读)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=eb0214221999, createdName=shuangle, createdTime=Fri Aug 19 12:52:00 CST 2011, time=2011-08-19, status=1, ipAttribution=)]
    2011-08-19 shuangle

    #指南解读#

    0

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