Осложнение догоспитального тромболизиса у пациентов с острым коронарным синдромом

Статья в Elpub

Журнал МедиАль. 2018; : 104-107

Осложнение догоспитального тромболизиса у пациентов с острым коронарным синдромом

Мухин А. С., Иванова Я. А., Шарабрин Е. Г., Федоров С. А.

Аннотация

Данный обзор посвящен проблеме осложнений при догоспитальном тромболизисе у пациентов с острым коронарным синдромом. Существует много противопоказаний к тромболизису, и усилия должны быть направлены на то, чтобы выбрать тех пациентов, которые не имею противопоказаний. В обзоре разъясняются патофизиологические механизмы, которые повышают риск кровотечения после тромболизиса. Фибринолитики являются эффективной реперфузионной терапией для многих пациентов с инфарктом миокарда ST (STEMI), но их необходимо вводить в сжатые сроки. Задержка выполнения реперфузии на каждые 30 минут приводит к увеличению относительного показателя смертности на 10%. Многие факторы могут способствовать задержке в терапии. Пациенты, могут находиться в отдаленных от первичных сосудистых центров районах. В этих условиях догоспитальная фибринолитическая терапия, выполняемая бригадой скорой помощи до прибытия в отделение неотложной помощи, может уменьшить время реперфузии. Пациенты с инфарктом миокарда, получающие фибринолитическую терапию в первые 30 минут, после прибытия бригады скорой медицинской помощи, имеют лучшие показатели по сравнению с пациентами, получающими тромболизис через 60 минут от начала инфаркта миокарда.

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MediAl. 2018; : 104-107

Complications of prehospital thrombolysis in patients with acute coronary syndrome

Mukhin A. S., Ivanova Ya. A., Sharabrin E. G., Fedorov S. A.

Abstract

In cases of drug and endovascular myocardial reperfusion the risk of complications decreases due to the reduction of load on infarct related artery. This review is devoted to the problem of complications in prehospital thrombolysis in patients with acute coronary syndrome. There are many contraindications to thrombolysis, and efforts should be made to select those patients who do not have contraindications. The review explains the pathophysiological mechanisms that increase the risk of bleeding after thrombolysis. Fibrinolytics are an effective reperfusion therapy for many patients with myocardial infarction ST (STEMI), but they need to be administered on a tight schedule. For each 30-minute reperfusion delay, approximately 10% of the relative increase in the risk of death. No serious complications such as cerebral circulation and myocardial embologenic were detected among patients with acute myocardial infarction with ST segment elevation in the group with formed thrombus aspiration. As for a group with prehospital thrombolysis, there were no deaths in it, indicating the effectiveness of thrombolysis as a preventive measure.

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31. Collet J.P., Montalescot G.; The acute reperfusion management of STEMI in patients with impaired glucose tolerance and type 2 diabetes. Diabetes Vase Dis Res. 2 2005:136-143.

32. Costa JR Jrl, Abizaid A, Dudek D., et al. Rationale and design of the MGuard for acute ST elevation reperfusion MASTER trial. Catheter Cardiovasc Interv. 2013 Aug 1 ;82(2): 184-90.