心肌梗塞之藥物治療新進展

Drug Therapy for Myocardial Infarction

陳永平(Yung-Ping Chen) ； 花士哲(Shih-Che Hua) ； 洪培豪(Peir-Haur Hung) ； 陳宗賢(Tsung-Hsien Chen) ； 張瑞月(Rei-Yeuh Chang)

《內科學誌》 28卷3期 (2017/06) Pp. 148-159

https://doi.org/10.6314/JIMT.2017.28(3).05

摘要

心肌梗塞的治療，近年來在台灣藉由緊急醫療網的設立，及各醫學中心與區域醫院設置急、重症科後，有長足的進步。當心肌梗塞的病患抵達急診室時，首先由急診科專科醫師利用心電圖快速正確診斷STEMI 或NSTE-ACS (NSTEMI 及不穩定性心絞痛)，及給予口服雙重抗血小板凝聚劑與肝素等初步藥物治療。心臟專科醫師則對STEMI 的病患若在症狀發作之黃金12 小時內，即刻進行緊急心導管檢查和90 分鐘內將冠狀動脈病灶打通。而NSTE-ACS 的病患依其嚴重程度來給予最適當的治療。當病患接受心導管和冠狀動脈介入治療後，由加護病房重症科專科醫師進行後續照顧。然而，心肌梗塞病患之藥物治療是長期、不可間斷地，而且心肌梗塞後會造成心臟衰竭、心肌纖維化等後續問題。本文以專文介紹目前心肌梗塞藥物處置方法與近期的研究成果。在每位臨床醫師的行醫歲月中，必會遇到心血管相關疾病與心肌梗塞的病患，因此，了解心肌梗塞的藥物治療是急診科、重症科和所有內科專科醫師都必須面對的功課。施予必要、適當的藥物治療是每位醫師的責任和義務。

關鍵字

心肌梗塞(Myocardial Infarction) ； 非ST節段升高之心肌梗塞(Non-ST-segment elevation myocardial infarction ； NSTEMI) ； ST節段升高之心肌梗塞(ST-segment elevation myocardial infarction ； STEMI) ； 非ST節段升高之急性冠心症(Non-ST-elevation acute coronary syndromes ； NSTE-ACS) ； 藥物治療(Drug therapy)

並列摘要

In recent years, the myocardial infraction (MI) management in Taiwan has been tremendously improved with the establishment of national Emergency Medical Service System (EMSS) and the Emergency Critical Care Department in medical centers and regional hospitals. When a patient presents to the ER with myocardial infarction, he would immediately receive examination with 12-leads electrocardiography by emergency specialist to clarify as ST-elevation myocardial infarction (STEMI) or non-ST-elevation acute coronary syndromes (NSTE-ACS). He would also receive the oral dual antiplatelet agents (DAPT) and intravenous heparin as the initial treatment. If patient is diagnosed with STEMI, a cardiologist would perform primary percutaneous coronary intervention (PCI) for the patient to recanalize the culprit coronary lesion within 90 minutes with 12hrs of symptom onset. For patient with NSTE-ACS, an appropriate treatment will be provided for the patient according the risk stratification. Intensive Care Unit (ICU) specialist would be responsible for the patient care in ICU. However, patient should receive long-term pharmacological therapy continuously during and after hospitalization. The common sequelae of MI are heart failure and cardiac fibrosis, which should be carefully monitored and prevented with the needed medication. In this article, we will focus on the current medical therapy for MI and latest research results. While every physician will face and manage patient with cardiovascular disease in the clinic career, it is important for the emergent specialists, ICU specialist, and internal specialist to understand the pharmacological drugs of MI. After all, to give the most adequate and update medical treatment to patients is the responsibility and obligation of every physician.