不具备PCI条件的医疗机构对STEMI患者再灌注治疗的处理策略

Reperfusion strategy for patients with ST-segment elevation myocardial infarction in hospitals without PCI facility

对于不具备介入条件的医疗机构,溶栓仍是处理ST段抬高型急性心肌梗死(STEMI)的重要措施。然而,对于STEMI患者溶栓后应该采取怎样的后续处理目前仍无定论。过去认为溶栓后应尽量采取保守治疗,《经皮冠状动脉介入治疗指南(2009)》也提出溶栓成功后应依据缺血与否对患者进行评估,然后决定是否转运行经皮冠状动脉介入治疗(PCI),但是支持这一观点的循证医学证据不足。近年来的几项临床研究结果提示,STEMI患者无论溶栓成功与否,对于不具备PCI条件的医院,立即转运行PCI可能是降低患者主要心血管事件发生率的最合适的方法。

Thrombolysis is still an important treatment modality in patients with ST-segment elevation myocardial infarction （STEMI） in a hospital without percutaneous coronary intervention （PCI） facility. However, the optimal treatment after thrombolysis is still unclear. Conservative treatment after thrombolysis was recommended in the past. ＂Guidelines for percutaneous coronary intervention （2009）＂ also suggested that the condition of STEMI patients should be evaluated to determine whether the patient should be transferred to a hospital with PCI facility. But this suggestion lacksed evidence-based support. In recent years, several clinical trials suggested that immediate transfer to the nearest interventional centre for PCI was plausible regardless of success or failure in thrombolysis in local hospital, and this might reduce the incidence of cardiovascular events in patients with STEMI.