颜红兵,向定成,刘红梅,陈辉,陈纪言,陈玉国,陈韵岱,楚英杰,方唯一,傅向华,李春洁,毛威,潘曙明,史若飞,苏晞,王焱,王贵荣,王伟民,徐梅,杨丽霞,于海玲,袁祖贻,郑志杰,霍勇

• 1:国家心血管病中心中国医学科学院阜外医院心内科
• 2:中国人民解放军广州总医院心内科
• 3:北京急救中心
• 4:广东省人民医院心血管内科

摘要(Abstract)：

<正>急性心肌梗死仍然严重威胁我国人民健康,在我国广大城乡地区,形势十分严峻[1-2]。及时救治急性心肌梗死患者,降低死亡率和保护心脏功能刻不容缓。鉴于我国的实际情况,院前溶栓治疗在大城市以外的城乡地区具有重要意义。为此,中国医师协会胸痛专业委员会及中国医学救援协会心血管急救分会专门组织有关专家制订了本共识,旨在帮助

关键词(KeyWords)： ST段抬高型心肌梗死;溶栓治疗;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 颜红兵,向定成,刘红梅,陈辉,陈纪言,陈玉国,陈韵岱,楚英杰,方唯一,傅向华,李春洁,毛威,潘曙明,史若飞,苏晞,王焱,王贵荣,王伟民,徐梅,杨丽霞,于海玲,袁祖贻,郑志杰,霍勇

参考文献(References)：

• [1]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2016》概要.中国循环杂志,2017,32(6):521-530.
• [2]RossellóX,Huo Y,Pocock S,et al.Global geographical variations in ST-segment elevation myocardial inf arction management and post-discharge mortality.Int J Cardiol,2017,245:27-34.
• [3]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南.中华心血管病学杂志,2015,43(5):380-393.
• [4]O'Gara PT,Kushner FG,Ascheim DD,et al.2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction:a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines.Circulation,2013,127(4):e362-e425.
• [5]Ibanez B,James S,Agewall S,et al.2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation:the task f orce f or the management of acute myocardial inf arction in patients presenting with ST-segment elevation of the European Society of Cardiology(ESC).Eur Heart J,2018,39(2):119-177.
• [6]Gibson CM,Pride YB,Buros JL,et al.Association of impaired thrombolysis in myocardial inf arction myocardial perf usion grade with ventricular tachycardia and ventricular fi brillation fbllowing fi brinolytic therapy for ST-segment elevation myocardial infarction.J Am Coll Cardio1,2008,5l(5):546-551.
• [7]WidimskyP,BudesínskyT,Vorác D,et al.Long distance transport f or primary angioplasty vs immediate thrombolysis in acute myocardial infarction.Final results of the randomized national multicentre trial--PRAGUE-2.Eur Heart J,2003,24(1):94-104.
• [8]Pinto DS,Frederick PD,Chakrabarti AK,et al.Benefit of transf erring ST-segment-elevation myocardial inf arction patients for percutaneous coronary intervention compared with administration of onsite fibrinolytic declines as delays increase.Circulation,2011,124(23):2512-2521.
• [9]Danchin N,Coste P,Ferrières J,et al.Comparison of thrombolysis following the broad use of percutaneous coronary intervention with primary coronary intervention for ST-segmentelevation myocardial infarction:data f rom the French registry on acute ST-elevation myocardial inf arction(FAST-MI).Circulation,2008,118(3):268-276.
• [10]Bonnefoy E,Steg PG,Boutitie F,et al.Comparison of primary angioplasty and pre-hospital f ibrinolysis in acute myocardial infarction(CAPTIM)trial:a 5-year follow-up.Eur Heart J,2009,30(13):1598-1606.
• [11]Armstrong PW,Gershlick AH,Goldstein P,et al.Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction.N Engl J Med,2013,368(15):1379-1387.
• [12]Welsh RC,Chang W,Goldstein P,et al.Time to treatment and the impact of a physician on prehospital management of acute ST elevation myocardial infarction:insights from the ASSENT-3PLUS trial.Heart,2005,91(11):1400-1406.
• [13]Roule V,Ardouin P,Blanchart K,et al.Prehospital fi brinolysis versus primary percutaneous coronary intervention in ST-elevationmyocardial infarction:a systematic review and meta-analysis of randomized controlled trials.Crit Care,2016,20(1):359.
• [14]Gershlick AH,Stephens-Lloyd A,Hughes S,et al.Rescue angioplasty after failed thrombolytic therapy for acute myocardial infarction.N Engl J Med,2005,353(26):2758-2768.
• [15]Madan M,Halvorsen S,Di Mario C,et al.Relationship between time to invasive assessment and clinical outcomes of patients undergoing an early invasive strategy after fibrinolysis for ST-segment elevation myocardial infarction:a patient-level analysis of the randomized early routine invasive clinical trials.JACC Cardiovasc Interv,2015,8(1 Pt B):166-174.
• [16]罗望胜,向定成,张金霞,等.远程实时传输12导联心电图对急性ST段抬高性心肌梗死患者的院前诊断价值.中华急诊医学杂志,2013,22(6):669-673.
• [17]段天兵,向定成,秦伟毅,等.建立区域协同救治网络对首诊于非冠状动脉介入治疗医院的急性心肌梗死患者再灌注时间及近期预后的影响.中华心血管病杂志,2014,42(8):641-645.
• [18]急性心肌梗死再灌注治疗研究协作组.重组葡激酶与重组组织型纤溶酶原激活剂治疗急性心肌梗死的随机多中心临床试验.中华心血管病杂志,2007,35(8):691-696.
• [19]Han YL,Liu JN,Jing QM,et al.The efficacy and safety of pharmacoinvasive therapy with prourokinase for acute STsegment elevation myocardial infarction patients with expected long percutaneous coronary intervention delay.Cardiovasc Ther,2013,31(5):285-290.
• [20]Yusuf S,Mehta SR,Chrolavicius S,et al.Effects of fondaparinux on mortality and reinfarction in patients with acute STsegment elevation myocardial infarction:the OASIS-6randomized trial.JAMA,2006,295(13):1519-1530.
• [21]Berwanger O,Nicolau JC,Carvalho AC,et al.Ticagrelor vs clopidogrel after fi brinolytic therapy in patients with ST-elevation myocardial Inf arction:a randomized clinical trial.JAMA Cardiol,2018.[Epub ahead of print]
• [22]Tjandrawidjaja MC,Fu Y,Westerhout CM,et al.Resolution of ST-segment depression:a new prognostic marker in ST-segment elevation myocardial infarction.Eur Heart J,2010,31(5):573-581.
• [23]向定成,于波,苏晞,等.规范化胸痛中心建设与认证.北京:人民卫生出版社,2017:9-12,218-226.
• [24]国家卫生和计划生育委员会.胸痛中心建设与管理指导原则(试行).2017-10-22.http://www.nhfpc.gov.cn/yzygj/s3594q/201711/236dd7bf62434d109049dced2a2ed8ec.shtml.