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在患过心肌梗塞病人的各种死亡方式中,以猝死最为常见。猝死的机制还不十分清楚,但已提出几种假设。一般都把猝死归咎于以下因素:(1)左冠状动脉主干中的血栓;(2)纤维蛋白和血小板构成的微血栓的移动,导致心肌缺血,再引起严重的心律失常;(3)慢性心肌缺血导致的心律失常;(4)冠状动脉痉挛引起缺血及心律失常。必须作进一步研究制造一个动物模型来研究猝死的病理生理学。关于在心肌梗塞后如何预防猝死的问题,曾经针对可能导致猝死的多种因素,提出并研究了几种治疗方法。复习已经发表了的临床治疗试验,得出如下的看法: 1.迄今还没有明显有效的办法,用安妥明控制血胆固醇在二级预防(对心梗后病人预防猝死及心梗复发——译者注)方面未收到什么效果;2.对于抗凝疗法仍然有争论;在美国和欧洲,仍在继续研究抗血小板药物及β受体阻滞剂的应用,有希望在今后若干年内得到某些结果。不管怎样,为了检验联合疗法的效果,很有必要进行新一代的临床试验研究。本文中心内容;猝死,次级预防,心肌梗塞,一般评论。
Sudden death is the most common form of death among patients with myocardial infarction. The mechanism of sudden death is not yet clear, but several hypotheses have been made. Sudden death is generally attributed to the following factors: (1) thrombosis in the left coronary artery; (2) fibrin and platelet microthrombi formation of movement, leading to myocardial ischemia, causing severe arrhythmia; (3) chronic Arrhythmia caused by myocardial ischemia; (4) coronary artery spasm caused by ischemia and arrhythmia. Further research must be done to create an animal model to study the pathophysiology of sudden death. Regarding how to prevent sudden death after myocardial infarction, several treatments have been proposed and studied for a number of factors that may lead to sudden death. Review of published clinical trials, come to the following view: 1. so far there is no clear and effective way to use clofibrate to control blood cholesterol in secondary prevention (after myocardial infarction patients with sudden death and myocardial infarction recurrence 2) There is still debate on anticoagulant therapy; in the United States and Europe, the continued use of antiplatelet agents and beta-blockers has been promising in the coming years Some results. In any case, in order to test the effect of combination therapy, it is necessary to carry out a new generation of clinical trial. The content of this article; sudden death, secondary prevention, myocardial infarction, general comment.