BMJ:ST段抬高心梗介入治疗后,都应收入重症监护室

2019-06-16 朱柳媛 中国循环杂志

很多人都知道,一旦发生急性心肌梗死,需要尽快进导管室开通血管,但很少有人知道,这类患者开通血管后需要住重症监护病房(ICU)还是普通病房。目前,只有欧洲相关指南建议这类患者入住ICU。

很多人都知道,一旦发生急性心肌梗死,需要尽快进导管室开通血管,但很少有人知道,这类患者开通血管后需要住重症监护病房(ICU)还是普通病房。目前,只有欧洲相关指南建议这类患者入住ICU。

近期,美国密歇根大学研究人员发表在《英国医学杂志》上的一项大规模回顾性队列研究提示,对于ST段抬高型心肌梗死发作后ICU住院指征不明确(可住,也可不住)的患者,在重症监护室进行恢复治疗可降低其30天死亡率。

研究者表示,该研究结果令人惊讶,因为其他研究都显示ICU在这类患者中是使用过度的。

但他们强调,ICU住院就像一种类似药物的治疗手段,该研究结果并不意味着每一例ST段抬高型心肌梗死患者都需要送去ICU进行恢复治疗,目前迫切需要进一步确定他们中的哪些患者能从ICU住院中获益。

研究者还指出,建立ICU的初衷是给病重的患者进行治疗,如果把每一例ST段抬高型心肌梗死患者送进ICU治疗,风险是比较大的,包括感染,因为ICU中真正病重的患者极易存在艰难梭菌等严重感染

另外,在ICU住院的患者更有可能接受各种手术操作治疗,且因频繁接受护理或治疗而睡眠质量较差。这些对病情不太严重的患者来说,是具有破坏作用的。

该研究覆盖全美1727家急救医院,纳入近11万例因ST段抬高型心肌梗死住院的老年患者,其中68.8%在ICU住院,大部分是在导管室开通血管后住进去的。

在ICU入院率处于最高四分位的医院中,至少85%的患者是在ICU住院的。

当是否入住ICU治疗根据患者与ICU入院率最高的医院之间的距离远近来决定时,ICU住院者的30天死亡率比普通病房住院者降低了6.1%。

在另一项针对非ST段抬高型心肌梗死患者的分析中,研究者发现,这类患者常规入住ICU并没有获得预后改善,是否入住ICU并不会明显影响死亡率。

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    2019-09-18 gaoxiaoe
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    2019-06-18 gdsun
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    2019-06-18 bioon6
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    2019-06-18 hyf035
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    2019-06-16 天地飞扬

    学习,谢谢分享!

    0

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