Morphine Sulfate

引言 胸痛是临床常见症状之一，导致胸痛的病因复杂，病情的严重程度相差很大。对于高危患者，症状发作后启动治疗越早，疗效越好，获益越多。因此，急性胸痛患者的早期鉴别和危险分层，对于识别高危患者并给予及时正确的处置具有重要意义。 近期，我们邀请了来自重庆医科大学附属第一医院的蒲鹏教授，向我们阐述了急性胸痛的临床诊疗策略，本文将梳理精彩内容，以饕读者。 一、胸痛的认识 急性胸痛是急诊内科最常见的症状之一，急性胸痛的病因较多，病情千变万化，危险性存在较大差异。应尽早识别急性冠脉综合征（ACS）、主动脉夹层、肺栓塞、气胸、急性心肌心包炎等高危疾病，并给予及时、正确的处理。值得注意的是，实际上仅有15%~25%的急性胸痛是ACS可能。在处理急诊胸痛时，应积极寻找引起症状的其他病因，不应将胸痛视为ACS的特有症状，易造成误诊。 二、临床上如何快速诊断和鉴别诊断急性胸痛？ 诊断急性胸痛主要包括以下5大方面，分别为：症状、体征、心电图（ECG）、化验和影像学检查。关于胸痛的问诊，需询问患者的发病年龄、疼痛部位、疼痛性质、持续时间、诱因及缓解因素、伴随症状。胸痛部位不同，对应不同疾病，包括以下方面： 心前区疼痛：见于心绞痛、急性心肌梗死（AMI）、心包炎、心肌炎、夹层、主动脉瘤； 胸骨后疼痛：多见于心绞痛、急性心肌梗死、心包炎、心肌炎、食管疾病、纵隔疾病等； 后背痛：见于脊柱疾病、主动脉夹层动脉瘤、胰腺炎等； 左肩部放射痛：多见于心绞痛、急性心肌梗死、夹层动脉瘤； 上腹痛疼痛：见于胃部疾病、胰腺炎、心绞痛、心肌梗死等。 但应注意，上牙以下，肚脐以上的疼痛或任何不明原因的不适都应该警惕ACS可能，一定要行心电图检查。 三、急性胸痛的诊断思路 首先应迅速的询问病史、查体及辅助检查（ECG、胸片、心肌损伤标志物等），其次区分胸痛为高危或低危，区分胸痛为心源性或非心源性，应注意高危胸痛的识别是关键！高危胸痛特征为急、重、猛，高危胸痛可根据患者的表情、症状及体征等方面进行快速识别。 四、ACS的临床诊疗策略 1 10 min后完成首份心电图 心电图是早期快速识别ACS的重要工具，10 min内应完成首份12/18导联心电图检查。非ST抬高型急性冠脉综合征（NSTE-ACS）的心电图典型表现为至少2个相邻导联ST段压低≥0.1 mv或者T波改变，并呈动态变化；变异型心绞痛可表现为一过性ST段抬高；初始心电图正常，不能除外NSTE-ACS，如胸痛持续不缓解，需要每间隔5~10 min复查1次心电图。ST抬高型急性冠脉综合征（STEMI）的心电图表现为典型表现为2个或以上导联ST段弓背抬高；新发的左束支传导阻滞也提示STEMI；心电图表现为缺血相关导联的T波高耸提示为STEMI超急性期。 2 完善心肌损伤标志物的检测——肌钙蛋白（cTn） 当cTn升高，且至少1个值高于参考上限（URL）时，应使用“心肌损伤”一词。如果cTn值升高和/或降低，则考虑为急性心肌损伤。当存在急性心肌损伤且临床上有急性心肌缺血迹象，且检测到cTn值上升和/或下降，且至少1个值高于第99百分位URL，且至少1个值符合以下条件时，应使用“急性心肌梗死”一词： 缺血症状； 新发生的缺血性ECG改变； 病理性Q波形成； 影像学证据显示有新的心肌活性丧失或新发的局部室壁运动异常； 冠脉造影或尸检证实冠状动脉内有血栓。 3 药物治疗支持 溶栓治疗：对于STEMI患者，如无条件进行介入治疗，可给予溶栓药物如尿激酶、瑞替普酶等溶解血栓，恢复冠状动脉血流； 抗血小板治疗：给予阿司匹林、替格瑞洛等抗血小板药物，抑制血小板聚集，防止血栓形成和扩大； 镇痛治疗：对于胸痛剧烈的患者，可给予吗啡等镇痛药物缓解疼痛，减轻患者焦虑和恐惧情绪； 其他药物治疗：根据患者病情和医生建议，可给予其他相关药物治疗，如抗心律失常药物、降压药物等。 4 非药物治疗 心电监护：持续进行心电监护，密切观察患者心率、心律和血压等生命体征变化，及时发现和处理异常情况； 休息与饮食调整：患者需卧床休息，避免过度活动和情绪激动；同时调整饮食结构，以清淡易消化为主，保持大便通畅； 介入与外科手术治疗：对于有条件的医院和患者，可尽快进行急诊冠状动脉介入手术，实现血运重建； 吸氧及呼吸机治疗：对需要的患者给予吸氧及呼吸机支持，提高血氧饱和度，改善心肺状况。 5 心律失常监测及处理技巧 严密监测心电图：持续心电监护，及时发现心律失常； 准备抢救设备：备好除颤器、起搏器等抢救设备，以便随时进行抢救； 药物治疗：根据心律失常类型，选用适当的抗心律失常药物； 电复律治疗：对于严重心律失常，如室颤、室速等，应及时进行电复律治疗。 欢迎投稿：学术成果、前沿进展、临床干货等主题均可，点此了解投稿详情。 免责声明：药明康德内容团队专注介绍全球生物医药健康研究进展。本文仅作信息交流之目的，文中观点不代表药明康德立场，亦不代表药明康德支持或反对文中观点。本文也不是治疗方案推荐。如需获得治疗方案指导，请前往正规医院就诊。 分享，点赞，在看，传递医学新知

Bicycle Health, a company that offers virtual opioid disorder treatment, announced it secured $16.5 million in funding. Existing Questa Capital led the round with participation from other existing investors, including Frist Cressey Ventures, SignalFire, Hustle Fund, Valeo Ventures, City Light Capital and InterAlpen Partners. New investor JSL Health also joined the round. The Boston-based company touts that it reached profitability in Q4 2024 and, in December, appointed Manu Kuppalli as its new chief financial officer and Andy Thomas as chief operating officer. WHAT IT DOES Bicycle Health offers virtual opioid use disorder treatment, including medication-assisted therapeutic options like Suboxone, a medication that treats dependence on opioid drugs like heroin and morphine. Patients can set up an introductory call with the startup to determine if Bicycle's treatment would work for them. They then schedule a virtual appointment to set a care plan and discuss medication-assisted treatment. Patients can also access health coaching and online support groups. The company says it will use the new round of funding to expand access to its care model through partnerships with payers and health systems, hire additional addiction medication specialists, expand its offerings to high-risk patients such as adults in custody and build out its technology offerings. "Our mission has always been to help as many people as possible access the treatment they need to achieve long-term recovery," Ankit Gupta, founder and CEO of Bicycle Health, said in a statement. "Millions of people struggle with opioid use disorder and tens of thousands of people die from opioid use every year. Our virtual care model is proven to keep patients in treatment longer, reduce overdose rates, and improve access to treatment for people who need it. We're grateful to continue to provide lifesaving care to patients across the country, and plan to expand to more patients and families who need support in 2025." MARKET SNAPSHOT Last year, teletherapy company Talkspace launched the Behavioral Health Consortium, an offering allowing clinicians to refer insured members with high-acuity needs to in-network specialty-care providers for alcoholism, substance use and eating disorder treatments. The network included Bicycle Health, outpatient mental health support company Charlie Health and alcohol use treatment organization Ria Health. Months prior, Bicycle and Talkspace announced a partnership to expand access to virtual care for patients of both companies. Talkspace patients would have access to Bicycle's opioid use disorder specialty care, and Bicycle Health will be able to connect with Talkspace therapists via chat and speak to mental health providers in areas outside of substance use disorder, such as marriage and family therapists. In 2023, supermarket chain Albertsons and Bicycle Health partnered to allow the telehealth company's providers to prescribe buprenorphine monthly injections for opioid use disorder that can be filled inside Albertsons pharmacies across 17 states. Buprenorphine is an opioid used to treat opioid use disorder as well as acute and chronic pain. It has been shown to reduce the risk of death after an opioid overdose. In 2022, Bicycle secured $50 million in a Series B funding round, bringing its total Series B raise to $83 million. It also announced a partnership with emergency telehealth provider Tele911 to connect patients to continuing care after an overdose or health crisis. The company announced a $27 million Series A funding round a year before.