американские рекомендации по чкв 2011 года

  • Published on
    16-Jul-2015

  • View
    313

  • Download
    4

Embed Size (px)

Transcript

<ul><li><p> , -</p><p> - - </p><p>2011 </p></li><li><p> 2 </p><p>2011 ACCF/AHA/SCAI Guideline for </p><p>Percutaneous Coronary Intervention </p><p>American College of Cardiology Foundation, American Heart Association Task </p><p>Force on Practice Guidelines, Society for Cardiovascular Angiography and </p><p>Interventions, Glenn N. Levine, Eric R. Bates, James C. Blankenship, Steven R. </p><p>Bailey, John A. Bittl, Bojan Cercek, Charles E. Chambers, Stephen G. Ellis, Robert </p><p>A. Guyton, Steven M. Hollenberg, Umesh N. Khot, Richard A. Lange, Laura Mauri, </p><p>Roxana Mehran, Issam D. Moussa, Debabrata Mukherjee, Brahmajee K. </p><p>Nallamothu, and Henry H. Ting </p><p>J. Am. Coll. Cardiol. published online Nov 7, 2011; </p><p>doi:10.1016/j.jacc.2011.08.007 </p><p>This information is current as of November 15, 2011 </p><p>The online version of this article, along with updated information and services, is </p><p>located on the World Wide Web at: </p><p>http://content.onlinejacc.org/cgi/content/full/j.jacc.2011.08.007v1 </p></li><li><p> 3 </p><p> ACCF/AHA/SCAI 2011 </p><p> - , - . </p><p> Glenn N. Levine, MD, FACC, FAHA, Eric R. Bates, MD, FACC, </p><p>FAHA, - James C. Blankenship, MD, FACC, FSCAI, -Steven R. Bailey, MD, FACC, FSCAI John A. Bittl, MD, FACC Bojan Cercek, MD, FACC, FAHA Charles E. Chambers, MD, FACC, FSCAI Ste-phen G. Ellis, MD, FACC Robert A. Guyton, MD, FACC| Steven M. Hollenberg, MD, FACC Umesh N. Khot, MD, FACC Richard A. Lange, MD, FACC, FAHA Laura Mauri, MD, MSC, FACC, FSCAI Roxana Mehran, MD, FACC, FAHA, FSCAI Issam D. Moussa, MD, FACC, FAHA, FSCAI Debabrata Mukherjee, MD, FACC, FSCAI Brahmajee K. Nallamothu, MD, FACC Henry H. Ting, MD, FACC, FAHA ACCF/AHA. SCAI. . || ACCF/AHA . ACCF/AHA -. </p><p> ACCF/AHA Alice K. Jacobs, MD, FACC, FAHA, Jeffrey L. Anderson, MD, FACC, FAHA, Nancy Albert, PHD, CCNS, CCRN, FAHA Mark A. Creager, MD, FACC, FAHA </p><p>Steven M. Ettinger, MD, FACC, Robert A. Guyton, MD, FACC Jonathan L. Halperin, </p><p>MD, FACC, FAHA Judith S. Hochman, MD, FACC, FAHA Frederick G. Kushner, MD, </p><p>FACC, FAHA E. Magnus Ohman, MD, FACC William Stevenson, MD, FACC, FAHA </p><p>Clyde W. Yancy, MD, FACC, FAHA </p><p> , - - 2011 . - - 2011 . </p><p> - : Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, </p><p>Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, </p><p>Nallamothu BK, Ting HH. - ACCF/AHA/SCAI 2011 .: - , - - J Am Coll Cardiol 2011;58:XXXXX. </p><p> (www.cardiosource.org), (my.americanheart.org) - (www.scai.org) Circulation Catheterization and Cardiovascular Interven-tions. </p></li><li><p> 4 </p><p> ACCF/AHA/SCAI: , 2011 </p><p> , - . </p><p>: J. Am. Coll. Cardiol. published online Nov 7, 2011; doi:10.1016/j.jacc.2011.08.007 </p><p>http://content.onlinejacc.org/cgi/content/full/j.jacc.2011.08.007v1 </p><p> - : www.npsaik.ru </p><p> : : </p><p> .. ... .. </p><p> .. .. </p><p> , , , - - - ( ). - ; , ; , . : , , , - , , . </p></li><li><p> 5 </p><p> .......................................................................................... 8 </p><p> ............................................................................................................... 9 </p><p>1. ............................................................................................................... 14 </p><p>1.1. ............................................................. 14 1.2. ............................................................................................ 15 1.3. .............................................................. 15 1.4. .................................................................. 15 </p><p>2. ..................................................................... 16 </p><p>2.1. : . ........................................................................................................ 18 </p><p>2.2. : . ........................................................................................................ 21 </p><p>2.3. : . ........................................................................................................ 23 </p><p>2.4. ...... 24 2.5. ................................. 25 2.6. .................................................................................. 25 </p><p>2.6.1. BMS .............................................................................................. 26 2.6.2. DES ................................................... 27 </p><p>2.7. ................................... 28 </p><p>2.7.1. ............................................................................................... 28 2.7.2. , .. 28 2.7.3. ........................... 29 </p><p>2.8. . 30 </p><p>2.9. , ................................................................................................... 31 </p><p>2.9.1. ........................................................................................ 31 2.9.2. ................................................................ 31 2.9.3. ....................................................................... 32 2.9.4. .............................................................. 32 2.9.5. ............................................................................................. 33 2.9.6. / ST ...................................................................................... 33 </p><p>2.9.7. : ......................................................................................................... 34 </p><p>2.10. , ................................................................................................ 34 2.11. : ......................................................................................................... 34 </p><p>3. ................................................................................................. 36 </p><p>3.1. ................................................................................................. 36 </p></li><li><p> 6 </p><p>3.1.1. ............................................................................. 36 3.1.2. ...................................................................................... 36 3.1.3. ...................................................................................... 36 </p><p>3.2. .................................................................................... 37 3.3. ............................................................................................ 37 </p><p>4. ................................................................................................ 39 </p><p>4.1. ........ 39 4.1.1. ................................................................................................ 39 4.1.2. ....................................................................................................... 39 4.1.3. .............................................................................. 41 </p><p>4.2. ........................................................................................ 41 4.2.1. ....................................................................... 42 4.2.2. ................................................... 42 </p><p>4.3. . ...................................... 43 4.4. - . ................. 44 4.5. . ........................................ 45 4.6. . ........................................................ 46 4.7. : ..................................................... 46 </p><p>4.8. , . ............ 47 </p><p>5. ............................................................................................ 48 </p><p>5.1. : ........................................................... 48 5.2. ....................................... 53 </p><p>5.2.1. / ST: ................................................................ 53 5.2.2. ST ........................................ 54 5.2.3. : ........................................................... 59 </p><p>5.2.4. : ........................................................................ 62 </p><p>5.3. : .......................................................... 63 5.4. .............................. 65 </p><p>5.4.1. : ...................... 65 5.4.2. : ..... 66 5.4.3. ................................................... 67 </p><p>5.5. ................................... 68 5.5.1. : ........................ 68 5.5.2. : .................................................................. 68 5.5.3. : ............................................... 68 5.5.4. : ........................... 69 5.5.5. : ......................... 69 </p><p>5.6. : ......................................................................................................... 70 </p><p>5.7. ......................................................... 71 5.7.1. ...................................................................... 71 5.7.2. : ........... 72 5.7.3. : ........ 74 </p></li><li><p> 7 </p><p>5.7.4. ..................................................................... 77 5.7.5. No-Reflow: ... 83 </p><p>5.8. ............................... 84 5.8.1. : ............................... 84 5.8.2. : ..................................................... 84 5.8.3. : ........................................ 85 5.8.4. - : ............................................... 86 5.8.5. : ...................................... 87 </p><p>5.9. ............................................. 87 5.9.1. ....................................................................................................... 88 5.9.2. ........................................................................................................... 88 5.9.3. ....................................................................................................... 88 5.9.4. : ................................................................................... 88 5.9.5. .............................................................................. 89 </p><p>5.10. : .................. 89 5.11. : ................ 90 </p><p>6. ............................................................. 91 </p><p>6.1. : ... 91 </p><p>6.1.1. : ........................................................................................ 93 6.1.2. : ................................... 94 6.1.3. : ........................... 95 </p><p>6.2. ........................................................................................... 96 6.3. : ........................................................................... 96 </p><p>6.3.1. ...................................................... 97 6.3.2. ............................................ 98 6.3.3. BMS ...................................................... 98 6.3.4. DES ....................................................... 98 </p><p>6.4. .............................................................................. 98 6.4.1. : ......................................................... 99 6.4.2. .............................. 100 6.4.3. : .................................................... 100 </p><p>6.5. .......................................................................... 101 </p><p>7. .......................................... 103 </p><p>7.1. : ........................................ 103 7.2. . ......................................................................................................... 103 7.3. : ......................... 103 </p><p>7.4. . , : ............................... 104 </p><p>7.5. ACC NCDR ........... 105 </p><p>8. ...................................................................................... 105 </p><p> ........................................................................................ 106 </p><p> 4........................................................................................................ 130 </p></li><li><p> 8 </p><p> - - - - - - - ( P2Y12) </p><p> - ST - - ST ST - ST - - - - - - - - - -, - - - - - - - - (hazard ratio) </p><p> - - - - - - - - - - - - - - - - - </p><p>ACCF - American College of Cardiology </p><p>( ) BMS - - (bare-metal stents) - hronic total occlusion (- ) DES - (drug-eluting stents) </p><p>GP IIbIIIa IIbIIIa FDA - - (Food and Drug Administration) </p><p> - major adverse cardiac events (- -) SCAI - - </p></li><li><p> 9 </p><p> - , , , . - , - , -. , . , - , , , , . </p><p> (ACCF) - (AHA) 1980. ACCF AHA, -, - . - . </p><p> ACCF AHA - . -, ; , - . - , , , - . , , -, . </p><p> , - , , [1]. / , () / , , . () . A, B , 1. , -, , , -. , , C. , C, ( ), -</p></li><li><p> 10 </p><p> . , - C, . 1, - . III - - (): - . , - , I II ( A B) - - . </p><p> -, - () , ACCF/AHA ( , I). . </p><p> ACCF/AHA - , , , . -, , - , , . </p><p> ACCF/AHA -, , - , . -, . - . - , . , - . , - , . , - - ; - . </p><p>, , . , - - , - , - . , , , , , </p></li><li><p> 11 </p><p> , , IIa IIb, - . </p><p> 1 </p><p> I IIa IIb </p><p> III </p><p> III &gt;&gt;&gt; </p><p> &gt;&gt; -</p><p> - - </p><p> - - - ; </p><p> - -</p><p> / - / </p><p> - / </p><p> - - - / </p><p> / </p><p>- </p><p> III -- </p><p> - </p><p> III </p><p> - </p><p> , - / - - - , - - - - </p><p> -, / - - , - - - - </p><p> / - - - - , - - - </p><p> , - / - , - </p><p> , - / - -, - - - - </p><p> -, / - - , - - - </p><p> / - - - - , - - - </p><p> , - / , - - - </p></li><li><p> 12 </p><p> , - / - , - - </p><p> -, / - - -, - - </p><p> / - - - , - - </p><p> , - / , - </p><p>-- - -- </p><p> / - / </p><p> / - / / - , - - </p><p> / / - / - / / - - </p><p> , - / , - </p><p> - --# </p><p> / - - / - - B - , , - </p><p> / , , - - B , , </p><p> III - ___________ - - / - / .. / - - / - </p><p> III ____________ - / / </p><p> B C . , , - . . </p><p>*, , / - , , , , , . </p><p># ( I IIa; A B) , . </p><p> , , , - . - 12 , . -</p></li><li><p> 13 </p><p> 2009 ACCF AHA - (RWI), - , , 50% - (. 1 ). / -, . . -, , . , , , - 1. , , 1 2, . , , , , , , -. - : www.cardiosource.org/ACC/About-ACC/Leadership/Guidelines-and-Documents-Task-Forces.aspx. ACCF, AHA - (SCAI) - . - . </p><p> -, . , , - , ( Pub-Med) ( ),...</p></li></ul>

Recommended

View more >