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【論文摘要】若院前判斷出來是STEMI equivalent對患者有什麼益處，以Wellens syndrome為例
【論文摘要】What's the benefit to the patient if reconizes STEMI equivalent prehospital . For example , Wellens Syndrome
摘要
研究背景：因國人飲食習慣及作息不規律並且已邁入高齡化社會，心血管相關疾病人口數日益增加，消防人員在執行緊急救護所面臨心臟相關疾病之民眾也隨之增加，臨床較常見之典型心肌梗塞案件敏感度較以往提升，但相較於非典型心肌梗塞案件的辨識度仍不足。希望針對此案例研究，提升救護人員辨識相關非典型心肌梗塞的表徵以提升患者預後情形。研究方法（或案例描述）：69歲男性，因胸悶／胸痛、呼吸喘，報案送醫。有心肌梗塞、高血脂等病史，自去年12月即未規則服藥控制。到達現場病患意識清楚、生命徵象（T.P.R. 36.7 75 18）、血壓121/75 mmHg、血氧濃度98%，病患表示近一周斷續在休息中有胸悶情形，每天約發作1-2次，一次約持續1-2分鐘，無輻射痛、無盜汗、無噁心嘔吐、無呼吸喘等伴隨症狀，通常休息後可緩解。此次係因胸悶／胸痛加劇，疼痛指數為5分、持續約20分鐘，伴隨盜汗、呼吸喘，自行服用一次NTG未緩解，因此報案。現場心電圖無明顯ST段上升，考量疑似缺血性胸痛，排除禁忌症後即給予口服Aspirin 300 mg，協助送醫。院端心電圖呈現V2-V3雙相T波（先正後負）、V4-V5 ST段下降，懷疑Wellens syndrome，照會心臟科同時給予DAPT（雙抗血小板藥物治療）、Heparin（肝素），並於隔日安排心導管檢查，發現左前降支（LAD）近端阻塞約99％，經皮冠狀動脈氣球擴張及支架置入（POBAS）後，健康返家。研究結果（或案例討論）：急性心肌梗塞，尤其以ST段上升之心肌梗塞（STEMI），其預後與症狀發作到血管再灌流的時間呈現高度相關，意即接受再灌流的時間越短，對於受損的心肌細胞甚至整體死亡率，皆有顯著下降。惟，臨床上仍有10-25％持續進展的心肌缺血，亟需緊急介入冠狀動脈治療的病患，其心電圖呈現非典型、但又具極高風險可能近期造成嚴重阻塞的心電圖型態，臨床將稱之STEMI equivalent。盼藉以本案例之分享，為使患者避免演進成STEMI，可以盡早針對疑似半栓塞的血管做投藥或相對應的處置來避免惡化及盡早改善。
關鍵字
無資料並列摘要
Background: People in Taiwan have had a problem of irregular meal timing working hours. Moreover, Taiwan became an aged society. Therefore, the number of people with cardiovascular diseases has been increasing day by day . There are more and more people call an ambulance for people who are suffering from cardiovascular diseases; consequently, the sensitivity of the typical case of myocardial infarction increases than before. However, compared with the discrimination of typical myocardial infarction, that of atypical myocardial infarction is much more insufficient. Hence, through this study we wished that the EMT (emergency medical technician) will be equipped with the ability of identifying the performance of atypical myocardial infarction to improve patients' prognosis t. Methods (Or case presentation): The case will be shown as follows . A 69-year-old male called 119 for chest tightness/pain and shortness of breath and was sent to the hospital. He has a medical history of myocardial infarction and hyperlipidemia. What makes matters worse, he hadn't taken medicine regularly since December last year. At the scene, the patient stayed in clear conscious with vital signs (T/P/R), Bp 121/75 mmHg, saturation 98%. He said that he suffered from intermittent chest tightness during rest last week , which occurred 1-2 times a day and lasted about 1-2 minutes. He denied the accompanying symptoms, such as radial pain, cold sweating, nausea, vomiting and dyspnea which could be relieved after rest usually. Unfortunately, he suffered from more serious chest tightness then, with 5 points of pain index, lasting about 20 minutes , accompanying cold sweating and shortness of breath and taking an NTG by himself was invalid. The EKG didn't show the ST-segment elevation. EMT suspected that the patient suffered from myocardial ischemia, after ruling out the contraindications, he was given oral Aspirin 300 mg and sent him to the hospital . The EKG at the hospital showed biphasic T waves in V2-V3 (positive first and then negative), ST-segment depression in V4-V5. Wellens syndrome was suspected, therefore, ER (emergency room)consulted cardiology department. At the same time, the patient was given DAPT(Dual antiplatelet therapy) and heparin. Cardiac catheterization was arranged the next day, and it found that the proximal left anterior descending artery (LAD) was stenosis about 99%. After percutaneous coronary intervention (PCI), the patient discharged from hospital in good condition. Results (Or Case Discussion): The prognosis of acute myocardial infarction, especially ST segment elevation myocardial infarction (STEMI), is highly correlated with the time from symptoms onset to coronary reperfusion. That is, the shorter the time of reperfusion is , the lesser the damage to myocardial cells and even the overall death is. However, clinically, there are still 10~25% of patients suffer from progressive myocardial ischemia who need to receive PCI immediately. Unfortunately, the EKG of these patients don't show typical signs of STEMI instead of other atypical signs. Furthermore, these patients have high risk of developing a severe obstruction of coronary arteries. We call these EKG patterns STEMI equivalent. Including… we want to share our thoughts through this case. In order to prevent patients from developing to STEMI, we can use the medical treatments as soon as possible to avoid the condition from being worse.