The result of the development of research in cardiology revealed the opportunity to implement the concept of the “golden hour” to restore coronary blood flow, which formed a new attitude to myocardial infarction with the recognition of its emergency, treatment of which requires emergency hospitalization. In recent years, a sufficient number of multicenter studies have been conducted, the data of which provided an opportunity to formulate the main strategic directions of care for patients with acute coronary syndrome and became the basis for the development of clinical guidelines by leading national and international organizations. The aim of our research was to conduct a comparative analysis of modern approaches to the treatment of acute coronary syndrome in Ukraine and abroad. The research used logical, graphical methods and the method of system analysis. The article covers modern issues of classification of acute coronary syndrome, methods of its diagnosis and treatment. Based on the results of clinical studies, global trends in the diagnosis and treatment of acute coronary syndrome are shown. The article also discusses the organization of medical care, and in particular the possibilities and problems of reperfusion therapy in the treatment of acute coronary syndrome. Analysis of literature sources and own data indicate the existence of some problems in the treatment of acute coronary syndrome, among which significant factors in high mortality are late treatment and late hospitalization. Organizational measures to improve patient awareness, early diagnosis, and early reperfusion treatment are important steps in improving the prognosis of acute coronary syndrome.
The purpose of the study was to determine the prognostic value of asymmetric dimethylarginine in the development of complications in the hospital period of acute myocardial infarction with ST segment elevation in patients with type 2 diabetes mellitus. Material and methods. The study design consisted of 120 patients. They were divided into 2 groups. Group 1 consisted of patients with acute myocardial infarction and concomitant type 2 diabetes mellitus (n=70), group 2 included patients with acute myocardial infarction without concomitant type 2 diabetes mellitus (n=50). Patients of both groups matched on age and sex (60 men (50%) and 60 women (50%); their average age was 66.35±0.91 years, р<0.05). The control group consisted of 20 almost healthy people, among them 12 women (60%) and 8 men (40%) (average age was 45.17±2.88 years). The patients were divided into 3 tertiles according to the level of аsymmetric dimethylarginine (ADMA): ADMA ⩽1.45 μmol/l – 1st tertile; 1.45 μmol/l< ADMA ⩽1.98 μmol/l - 2nd tertile; ADMA >1.98 μmol/l - 3rd tertile. Results and discussion. The obtained results showed that the level of ADMA in patients with acute myocardial infarction in combination with type 2 diabetes was by 2.57 times (p <0.05) higher compared to patients without concomitant type 2 diabetes. In particular, the ADMA level was at 1.57±0.11 μmol/l in patients with acute myocardial infarction in combination with concomitant type 2 diabetes, while in patients with acute myocardial infarction without concomitant type 2 diabetes it was at 0.61±0.06 μmol/l. The ADMA value at >1.13 μmol/l in patients with acute myocardial infarction in combination with type 2 diabetes is a predictor of acute left ventricular failure. The ADMA tertiles were used to determine the acute myocardial infarction severity class based on the Killip scale. It is noteworthy that severer classes of acute myocardial infarction on the Killip scale were observed in a patient whose ADMA value belonged to the 3rd tertile group. We determined the ADMA value of A >2.08 μmol/l in patients with acute myocardial infarction in combination with type 2 diabetes, which was a predictor of a life-threatening condition of cardiogenic shock. Conclusion. The asymmetric dimethylarginine exhibits the following predictor properties: in relation to the development of acute left ventricular failure – at >1.13 μmol/l; in relation to the development of cardiogenic shock - at >2.08 μmol/l during the hospital period of acute myocardial infarction with ST-segment elevation in patients with concomitant type 2 diabetes. It is advisable to continue studying the marker of endothelial dysfunction (asymmetric dimethylarginine) as a predictor of adverse myocardial infarction in combination with concomitant type 2 diabetes
Актуальность. По данным Всемирной организации здравоохранения, в мире около 20 % людей умирает из-за отсутствия квалифицированной медицинской помощи на догоспитальном этапе, что определяет возрастание роли экстренной медицинской помощи (ЭМП) населению в системе здравоохранения. Именно поэтому обеспечение бесплатной, своевременной и эффективной медицинской помощью населения Украины при состояниях, угрожающих жизни больных, является одной из важнейших задач в сфере здравоохранения страны. Для исполнения положений Закона Украины «Об экстренной медицинской помощи» работа КУЗ «Центр экстренной медицинской помощи и медицины катастроф» (ЦЭМП и МК) Харьковской области в течение 2013–2017 гг. была направлена на улучшение показателей службы ЭМП и повышение ее качества. Цель — анализ динамики основных показателей деятельности службы ЭМП Харьковской области и разработка направлений совершенствования системы ЭМП. Материалы и методы. Проведен анализ отчетной документации учреждения «Центр экстренной медицинской помощи и медицины катастроф» Харьковской области за 2013–2017 гг. В ходе выполнения исследования использованы ретроспективный, статистический и математический методы анализа. Результаты. На сегодняшний день актуальной кадровой проблемой службы ЭМП и МК, вызванной крайне низкой материальной мотивацией, является дефицит работников. Так, согласно результатам проведенного исследования установлено, что показатель укомплектованности врачами в 2017 г. составляет 66,2 % (против 57,8 % в 2013 г.), средним медицинским персоналом — 84,7 % (против 86,0 % в 2013 г.), младшим медицинским персоналом — 73,7 % (против 82,5% в 2013 г.), водителями бригад ЭМП — 71,0 % (против 85,1 % в 2013 г.). За последние 5 лет увеличилось на 44,8 % среднесуточное количество обслуженных лиц бригадами ЭМП. При этом самый высокий уровень нагрузки приходится на врачебную общепрофильную бригаду и составляет 16,9 вызовов, самый низкий — на психиатрическую бригаду (7,7 вызова). В структуре причин вызовов в течение исследуемого периода преобладали выезды на внезапные заболевания (79,3 %) и несчастные случаи, травмы и отравления (10,4 %). При этом показатель своевременного прибытия бригад ЭМП на вызовы в городах составлял 97,8 % от общего количества экстренных вызовов, в условиях сельской местности региона — 98,1 %. Выводы. На основании результатов проведенного исследования авторами выявлены основные проблемы в организации оказания ЭМП населению и предложены основные направления ее совершенствования, что при успешной реализации позволит максимально удовлетворить потребности населения и рационально использовать все виды ресурсов системы здравоохранения.
Urgency. The period of a patient's hospitalization from the beginning of the disease has an important role in the provision of medical care. According to the Unified Clinical Protocol for the provision of medical care to acute coronary syndrome (ACS) patients, the latter must be hospitalized to an expert healthcare center in 90-120 minutes. That is why the main areas of pre-hospital care include the rapid recognition of acute myocardial infarction (AMI), stabilization of the patient's condition and his rapid transportation to the appropriate medical institution. The time from the appearance of the first symptoms of a heart attack to the arrival of the patient in the admission department of the hospital is an important factor influencing the course of AMI in further treatment, so to reduce the loss of time at this stage is important. The aim of the study was to analyze the time spent on the implementation of the protocol of assistance in AMI with the rise of the ST segment at direct stay of the emergency team on call. Materials and methods. A questionnaire survey of 85 emergency physicians working in Kharkiv was conducted. System approach, analytical, sociological
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