基于指南的ST段抬高型心肌梗死后长期二级预防治疗与风险因素控制最新进展

doi:10.12114/j.issn.1007-9572.2019.00.029

摘要/Abstract

摘要： ST段抬高型心肌梗死（STEMI）患者急性期的关键治疗是快速再灌注，成功再灌注后所有患者处于心血管事件再发极高危状态，需要依据国内外最新进展推荐进行二级预防治疗和风险因素控制。STEMI患者的长期管理治疗包括：心肌缺血的无创性评价，左心室功能和心源性猝死评价，戒烟，以运动为基础的心脏康复，饮食和体质量控制，血压控制，血糖管理，降脂治疗，长期抗栓治疗，β-受体阻滞剂，血管紧张素转换酶抑制剂（ACEI）和血管紧张素Ⅱ受体拮抗剂（ARB），盐皮质激素受体拮抗剂（MRA），改善循证治疗依从性，以及促进治疗协调性的医疗保健体系。

关键词: ST段抬高型心肌梗死, 风险评价, 二级预防, 药物疗法, 心脏康复

Abstract: In patients with ST-segment elevation myocardial infarction（STEMI），the key management is fast reperfusion therapy in the acute setting；after successful reperfusion，all patients are considered to be at sufficiently high risk to merit interventions for secondary prevention and risk factors based on the latest domestic and foreign evidence.Long-term management for STEMI includes noninvasive testing for ischemia，assessment of left ventricular function and risk for sudden cardiac death （SCD），cessation of smoking，exercise-based cardiac rehabilitation，diet advice and weight control，optimal blood pressure control，hyperglycemic management，lipid-lowering therapy，long-term antithrombotic therapy，beta-blockers，angiotensin-converting enzyme inhibitors（ACEI） and angiotensin Ⅱ receptor blockers（ARB），mineralocorticoid receptor antagonist （MRA） therapy，improvement of evidence-based treatment compliance，and system of care to promote care coordination.

Key words: ST-segment elevation myocardial infarction, Risk assessment, Secondary prevention, Drug therapy, Cardiac rehabilitation

梁峰,胡大一,方全,等. 基于指南的ST段抬高型心肌梗死后长期二级预防治疗与风险因素控制最新进展[J]. 中国全科医学, 2019, 22(8): 888-900. DOI: 10.12114/j.issn.1007-9572.2019.00.029.
LIANG Feng,HU Dayi,FANG Quan, et al. Recent Advances on Long-term Secondary Prevention and Risk Factors Control for ST-segment Elevation Myocardial Infarction Based on the Latest Evidence[J]. Chinese General Practice, 2019, 22(8): 888-900. DOI: 10.12114/j.issn.1007-9572.2019.00.029.

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