2. Analgesia
Analysis of retrospective data16 has raised a question about the potentially adverse effects of morphine in patients with unstable angina (UA)/non–ST-elevation myocardial infarction (NSTEMI). As a result, the recommendation for morphine pain relief has been reduced to a Class IIa recommendation for that patient population. Use of morphine remains a Class I recommendation for patients with STEMI, however, because STEMI patients should either have received reperfusion or are not candidates for reperfusion, and continuing pain requires relief in either case (Table 2). Because of the known increased risk of cardiovascular events among patients taking cyclooxygenase-2 (COX-2) inhibitors and other nonsteroidal anti-inflammatory drugs (NSAIDs),17–19 these drugs should be discontinued immediately at the time of STEMI (see 2004 STEMI Guidelines, Section 7.12.5, for additional discussion). 3,15,20,21 A substudy analysis from the ExTRACT TIMI-25 (Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment–Thrombolysis in Myocardial Infarction) trial22 demonstrated an increased risk of death, reinfarction, heart failure, or shock among patients who were taking NSAIDs within 7 days of enrollment. Longer-term management considerations and a discussion of the gradient of risk with the various NSAIDS are found in Section 7.12.5 of the 2004 STEMI Guidelines.15

 重點翻譯:

在不穩定心絞痛或者NSTEMI病患,使用嗎啡可能有不良的反應,所以嗎啡在這類病患的等級是 Class IIa 。

在STEMI病患,使用嗎啡止痛仍然是Class I ,持續性胸痛的病患可能需考慮是否適合做REPERFUSION治療,不過止痛還是需要一起做的。

在服用COX-2及其他NSAID類止痛藥物已知會增加心血管疾病的危險,當診斷STEMI時,即應該停用此類藥物。

在ExTRACT TIMI-25 臨床實驗,七天內曾使用NSAID的病患會增加其死亡率、再梗塞機率、心衰竭、休克的風險。

 

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