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目的探讨急性心肌梗塞(AMI)并心力衰竭的临床治疗方法。方法①所有病人均卧床休息、禁烟洒、控制盐的摄入量,合并心房纤颤、肺栓塞和感染(尤其是呼吸道感染),应分别予以治疗;②多巴酚丁胺60mg加硝酸异山梨酯注射液10mg加50g/L葡萄糖注射液250ml静脉滴注,每分钟15～20滴,持续静滴48～72h,后改为每日1次,7～10d为一个疗程,静滴中血压以不低于12/8kPa,心率增加不超过给药前20次/min为宜。FDP5.0g10min内快速静脉滴入,每日2次7～10d为一个疗程。将250g/L硫酸镁10ml,100g/L氯化钾10ml,普通胰岛素8U,注入100g/L葡萄糖注射液500mlk中静脉滴注,每日1次,14d为1个疗程。观察2周～1个月后心功能分级、超声心动图变化及临床表现。结果治疗后心率明显下降,心功能改善,每分钟心排出量(CO)升高,左室射血分数(LVEF)升高;显效26例(41.93%),有效29例(46.77%),无效7例(11.29%),有效率88.7%。结论动态观察AMI并心力衰竭患者心电图的演变及酶学变化,以防误诊、漏诊、及时纠正各种并发症,积极进行综合治疗,是治疗老年AMI并发心力衰竭的关键。
Objective To investigate the clinical treatment of acute myocardial infarction (AMI) and heart failure. Methods ① All patients were bed rest, no smoking sprinkle, salt intake control, with atrial fibrillation, pulmonary embolism and infection (especially respiratory infections), should be treated separately; ② dobutamine 60mg plus isosorbide dinitrate Ester injection 10mg plus 50g / L glucose injection 250ml intravenous drip, 15 to 20 drops per minute, continuous intravenous infusion 48 ~ 72h, changed to daily 1, 7 ~ 10d for a course of treatment, intravenous infusion of blood pressure Not less than 12 / 8kPa, heart rate does not increase more than 20 times before administration / min is appropriate. FDP5.0g rapid intravenous infusion within 10min, 2 times a day 7 ~ 10d for a course of treatment. The 250g / L magnesium sulfate 10ml, 100g / L potassium chloride 10ml, ordinary insulin 8U, injected 100g / L glucose injection 500mlk intravenous infusion, once daily, 14d for a course of treatment. After 2 weeks to 1 month, the changes of cardiac function, echocardiography and clinical manifestations were observed. Results After treatment, heart rate was significantly decreased, heart function improved, cardiac output (CO) increased per minute, left ventricular ejection fraction (LVEF) increased significantly; effective in 26 cases (41.93%), effective in 29 cases (46.77%), 7 cases (11.29%), the effective rate of 88.7%. Conclusion Dynamic observation of ECG changes and enzyme changes in patients with AMI and heart failure, in order to prevent misdiagnosis, missed diagnosis, promptly correct various complications, and actively carry out comprehensive treatment, is the key to the treatment of elderly AMI complicated with heart failure.