Cov ntsuas dab tsi yuav tsum tau kuaj pom hauv myocardial infarction

Myocardial infarction (Mbcardial infarction) yog qhov xwm txheej ceev. Nws yog vim mob occlusion ntawm coronary hlab ntsha, uas ua rau ib nrab necrosis ntawm ib feem ntawm myocardium vim ischemia. Ntau tshaj 95 feem pua ​​​​ntawm myocardial infarctions yog tshwm sim los ntawm coronary atherosclerosis hauv cov neeg laus thiab cov neeg laus. Mob myocardial infarction yog myocardial necrosis tshwm sim los ntawm qhov mob hnyav thiab tsis tu ncua ischemia thiab hypoxia ntawm coronary artery. Clinically, feem ntau muaj mob retrosternal mob, uas tsis tuaj yeem daws tau tag nrho los ntawm kev so thiab nitrates, nrog rau kev ua haujlwm ntawm cov ntshav hauv cov ntshav myocardial enzyme thiab kev hloov pauv ntawm electrocardiographic, uas tuaj yeem cuam tshuam los ntawm arrhythmia, poob siab lossis lub plawv tsis ua haujlwm, uas feem ntau tuaj yeem ua rau lub neej. - hem.

Kwv yees li ib nrab ntawm cov neeg mob uas mob myocardial infarction muaj cov tsos mob prodromal 1 mus rau 2 hnub lossis 1 mus rau 2 lub lis piam ua ntej qhov pib ntawm tus kab mob, qhov tshwm sim feem ntau yog exacerbation ntawm tus thawj angina pectoris, lub sij hawm tawm tsam ntev, los yog ua rau muaj kev cuam tshuam loj heev rau nitroglycerin; Rau cov neeg uas tsis muaj angina pectoris, sudden prolonged angina pectoris.

Cov khoom siv tshuaj ntsuam xyuas feem ntau siv:

1. Cov cim ntawm myocardial raug mob

Cardiac troponin T (cTnT): Thaum cov hlwb myocardial puas lawm, TnT raug tso tawm tam sim ntawd, thiab qhov nce ntawm TnT hauv cov ntshav tuaj yeem siv los nkag siab txog qib ntawm myocardial puas. ① Tus nqi ntawm kev kuaj mob myocardial raug mob: TnT thiab TnI kev soj ntsuam muaj qhov rhiab heev hauv kev kuaj mob myocardial infarction. Lawv pib sawv ntxov thiab kav ntev. Feem ntau, lawv sawv ntawm 2.7-4.9 teev ntawm qhov pib, ncov ntawm 5.8-29 teev, thiab rov qab mus rau qhov qub tsis pub dhau 5-14 hnub. , uas yog pab tau rau kev kuaj mob ntxov thiab nruab nrab lig; ② tsis ruaj tsis khov angina pectoris tuaj yeem nce siab thaum raug mob myocardial.

Myoglobin (Mb): Nws yog tus cim rhiab tshaj plaws rau kev kuaj mob myocardial infarction. Nws tshwm sim ntxov dua li lwm qhov ntsuas. Nws pib nce ntxiv hauv 1-2 teev ntawm qhov pib, nce mus txog qhov siab tshaj ntawm 6-8 teev, thiab pib rov qab mus rau qhov qub tsis pub dhau 24 teev. Kev kuaj mob ntawm tus mob myocardial infarction tuaj yeem txiav txim siab yog tias Mb tseem nyob hauv thaj tsam li 8 teev tom qab pib mob hauv siab. Mb txo qis thiab tom qab ntawd nce ntxiv los qhia qhov mob tshiab, yog li Mb tuaj yeem tsis tsuas yog siv los ua qhov taw qhia tseem ceeb rau kev ntsuas qhov loj ntawm infarct loj thiab rov ua tiav kev vam meej, tab sis kuj yog tus cim ntawm infarction tshiab thaum kho.

Creatine kinase isoenzyme (CK-MB): nce hauv 4 teev tom qab pib, thiab mus txog qhov siab tshaj ntawm 16 mus rau 24 teev. Tus nqi siab tshaj plaws tuaj yeem cuam tshuam txog qhov kev ua haujlwm ntawm infarction, thiab feem ntau rov qab mus rau theem ua ntej pib 3 mus rau 4 hnub tom qab pib.

2. Myocardial enzyme spectrum

Myocardial zymography yog ib qho tseem ceeb enzymatic Performance index rau kev kuaj mob. Creatine kinase (CK) nce hauv 6 teev tom qab qhov pib, nce siab hauv 1 hnub, thiab rov qab mus rau qib ua ntej qhov pib tshwm sim hauv 3-4 hnub; aspartate aminotransferase (AST) nce 6-12 teev tom qab pib, nce siab hauv 1-2 hnub, thiab rov qab mus rau qhov qub tsis pub dhau 1 lub lis piam; lactate dehydrogenase (LDH) nce 8-10 teev tom qab pib, nce siab hauv 2-3 hnub, thiab kav ntev li 2 lub lis piam poob mus rau qhov qub; -hydroxybutyrate dehydrogenase (-HBDH) yog ib qho enzyme tshwj xeeb hauv myocardium, uas pib nce 6h tom qab pib, mus txog qhov siab kawg ntawm 48h, thiab rov qab mus rau qhov qub tom qab 1 lub lis piam. Qhov piv ntawm -HBDH / LDH hauv tib neeg ib txwm yog 0.6 ~ 0.8, thiab qhov piv tau nce ntxiv hauv cov mob myocardial infarction, thaum qhov piv txwv no feem ntau txo qis hauv daim siab parenchymal cell lesions. Cov enzymes saum toj no txuas ntxiv txo lossis nce tom qab txo qis, thiab muaj peev xwm ua rau lwm tus mob myocardial infarction.

3. C-reactive protein, ntshav niaj hnub

CRP muaj kev koom tes ncaj qha rau cov kab mob plawv xws li o thiab atherosclerosis, thiab yog ib qho kev kwv yees thiab muaj feem cuam tshuam rau cov kab mob plawv.

1 mus rau 2 hnub tom qab pib ntawm tus kab mob, WBC thiab neutrophils nce (neutrophils ntau dua 80 feem pua), thiab eosinophils txo qis lossis ploj. ESR nce sai thiab tuaj yeem kav ntev li 1 txog 3 lub lis piam.

4. Coagulation series

Prothrombin lub sij hawm (PT), qhib ib nrab thromboplastin lub sij hawm (APTT), thrombin sij hawm (TT), D-dimer (DD) nce, thiab cov ntsiab lus fibrinogen (Fib) txo. Coagulation series tuaj yeem siv los ua qhov ntsuas ntsuas rau kev kho myocardial reperfusion. DD kuj tseem tuaj yeem siv los ua tus kwv yees ntawm kev rov tshwm sim tom qab mob myocardial infarction. Tom qab myocardial infarction, yog tias tus neeg mob qib DD tseem siab, qhov muaj peev xwm ntawm kev rov tshwm sim yog qhov siab.