高血糖对急性心肌梗死患者冠状动脉介入术后心肌组织水平灌注的影响  

Impact of Hyperglycemia on Myocardial Microcirculation Reperfusion in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention

作　　者：杨敏[1] 陈广玲[1] 陈畅[1] 张钰[1] 连耀植[1] 张汉灵[1] 

机构地区：[1]汕头大学医学院第一附属医院心血管内科,广东省汕头市515041

出　　处：《中国全科医学》2006年第20期1670-1672,共3页Chinese General Practice

摘　　要：目的探讨急性心肌梗死(acutemyocardial infarction,AMI)患者行急诊冠状动脉介入(percutaneous coronary intervention,PCI)术后心电图ST段下降与高血糖的关系,以揭示高血糖对心肌组织灌注的影响。方法急诊行PCI的AMI患者冠状动脉造影显示梗死相关血管(infarct-related artery,IRA)前向血流TIMI0～1级,PCI后IRA前向血流恢复到3级。术前行常规心电图、心肌酶检查及抗栓、抗心肌缺血等治疗。术后90min复查心电图。将患者分为两组:有糖尿病病史或者既往无糖尿病病史但入院血糖≥8mmol/L者列为I组,既往无糖尿病病史并且入院血糖<8mmol/L者列为Ⅱ组。比较两组患者术前、术后各导联ST段抬高的平均值及术前、术后ST段下降程度以及AMI并发症发生率。结果Ⅰ组患者无痛性心肌梗死较多见(P<0.05),导致发病到就诊的时间延长(P<0.05),其室性心律失常、心力衰竭、再发AMI、梗死后心绞痛及心血管死亡的发生率均高于Ⅱ组(P<0.05)。Ⅱ组和Ⅰ组相比,术后90min各导联抬高的ST段平均值及术前、术后ST段下降程度间差异有显著性意义(P<0.05)。结论AMI患者PCI治疗后心电图抬高的ST段下降程度受高血糖的影响;高血糖和高血脂影响PCI后心肌组织的微循环灌注;PCI后心肌组织的灌注状态与临床预后有关,高血糖患者发生AMI时预后不良。Objective To explore the relationship between ST- segment reduction and hyperglycemia in patients with acute myocardial infarction （AMI） treated with percutaneous coronary intervention （PCI） in order to reveal the impact of hyperglycemia on myocardial microcirculation reperfusion in patients with AMI after PCI. Methods 85 patients with AMI who underwent coronary arteriography after emergent hospitalization were enrolled. The blood flow of infarction related artery （IRA） was thrombolysis in myocardial infarction （TIMI） grades 0 - 1 and recovered to TIMI grade 3 after PCI. Electrocardiogram （ECG）, myocardium isoenzyme and anti - thrombus therapy were routinely performed before emergency PCI. ECG was reviewed in 90 minutes after operation. 85 patients were divided into two groups according to history of illness and the blood glucose level： group 1 （n =39） with blood glucose ≥8 mmol/L and group 2 （n =46） with blood glucose 〈8 mmol/L. The average ST- segment elevation and reduction were analyzed by statistics between two groups before and after PCI. Results The incidence of non - chest pain in group 1 was higher than that in group 2 （ P 〈 0. 05）. The incidence of ventricular arrhythmia, heart failure, AMI recrudescence, angina pectoris after AMI and death from cardiovascular disease were significantly higher in group 1 than those in group 2 （ P 〈0. 05）. The average ST - segment reductions after PCI were much higher in group 1 compared with group 2 （ P 〈 0.05）. Compared with group 2, the ST - segment reductions were much lower before and after PCI in group 1 （ P 〈 0.05）. Conclusion The ST - segment reduction degree is influenced by hyperglycemia in patients with AMI after PCI. The microcirculation reperfusinn in myocardium in patients with AMI after PCI is affected by hyperglycemia and blood lipid. Myocardial microcirculation reperfusion after PCI is related to clinical prognosis, it is a sign of bad prognosis when patients with hyperglycemia suffer AMI.

关 键 词：急性心肌梗死 经皮冠状动脉介入治疗 心电图 血糖 

分 类 号：R542.22[医药卫生—心血管疾病]