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РИСК И ВЫГОДА РЕПЕРФУЗИОННЫХ СТРАТЕГИЙ В ЛЕЧЕНИИ БОЛЬНЫХ ОСТРЫМ ИНФАРКТОМ МИОКАРДА С ПОДЪЕМОМ СЕГМЕНТА ST

https://doi.org/10.15829/1560-4071-2010-5-103-115

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Аннотация

В обзоре обсуждаются реперфузионные стратегии у больных с острым инфарктом миокарда с подъемом сегмента ST (ИМПST) с позиций результатов, представленных в международных клинических исследованиях. Даны современные представления об инвазивной и консервативной стратегиях в лечении ИМПST в реальной клинической практике в европейских странах. Наиболее существенное влияние на выживаемость пациентов имеет время, а не метод реперфузии. Стратегия первичного чрескожного коронарного вмешательства (ЧКВ) может не уменьшать смертность при задержке дверь-баллон более 60 мин по сравнению с немедленным проведением тромболитической терапии (ТЛТ). Стратегия ЧКВ имеет преимущество над ТЛТ только в том случае, если разница во времени между этими стратегиями (дверь-баллон – дверь-игла) менее 2-х часов. При выборе способа реперфузионной терапии следует учитывать риск пациента. Первичное ЧКВ имеет ограничения, связанные с тем, что эта методика не является общедоступной, требует специальной подготовки персонала и специального оснащения. Своевременное проведение ТЛТ является приемлемым стандартом оказания помощи при ИМПST. Этот подход наиболее актуален для России. Однако фармакоинвазивная стратегия должна быть предпочтительной опцией у пациентов, леченных ТЛТ. Особого внимания в обсуждении фибринолитических препаратов заслуживают препараты второго – алтеплаза (Актилизе® ) и третьего поколения – тенектеплаза (Метализе® ). До появления Метализе® непрерывная инфузия Актилизе® рассматривалась как золотой стандарт фармакологической реперфузионной терапии. Введение Метализе® в виде однократного болюса оказывается так же эффективно, как и непрерывно вводимая алтеплаза, но с лучшим профилем безопасности. Проведение ТЛТ на догоспитальном этапе с помощью одного болюса тенектеплазы (Метализе® ) за 5-10 сек предлагает уникальную клиническую возможность для раннего назначения терапии, что способствует максимальному спасению миокарда.

 

Об авторах

Т. М. Попонина
Сибирский государственный медицинский университет Росздрава, НИИ кардиологии СО РАМН, Томск
Россия
профессор кафедры кардиологии ФПК и ППС ГОУ ВПО


Ю. С. Попонина
Сибирский государственный медицинский университет Росздрава, НИИ кардиологии СО РАМН, Томск
Россия
врач кардиологического отделения №1


А. Г. Васильев
Сибирский государственный медицинский университет Росздрава, НИИ кардиологии СО РАМН, Томск
Россия
сотрудник


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Для цитирования:


Попонина Т.М., Попонина Ю.С., Васильев А.Г. РИСК И ВЫГОДА РЕПЕРФУЗИОННЫХ СТРАТЕГИЙ В ЛЕЧЕНИИ БОЛЬНЫХ ОСТРЫМ ИНФАРКТОМ МИОКАРДА С ПОДЪЕМОМ СЕГМЕНТА ST. Российский кардиологический журнал. 2010;(5):103-115. https://doi.org/10.15829/1560-4071-2010-5-103-115

For citation:


Poponina T.M., Poponina Y.S., Vasilyev A.G. RISKS AND BENEFITS OF REPERFUSION STRATEGIES IN ACUTE MYOCARDIAL INFARCTION WITH ST SEGMENT ELEVATION. Russian Journal of Cardiology. 2010;(5):103-115. (In Russ.) https://doi.org/10.15829/1560-4071-2010-5-103-115

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