血糖对急性心肌梗死患者预后和经皮冠状动脉介入治疗后心肌灌注的影响  

Impact of hyperglycemia on myocardial microcirculation reperfusion and prognosis in patients with acute myocardial infarction after percutaneous coronary intervention

作　　者：杨敏[1] 陈畅[1] 张钰[1] 闫纯英[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,515041

出　　处：《中国医师进修杂志》2008年第1期5-8,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 探讨血糖对急性心肌梗死（AMI）患者预后和经皮冠状动脉介入（PCI）治疗后心肌灌注的影响。方法 选取接受直接PCI治疗的AMI患者106例，将既往有糖尿病病史或者无糖尿病病史但入院时第1次随机血糖≥7．8mmol/L者列为高血糖组（49例），其余患者列为正常血糖组（57例）。比较两组患者术后梗死相关动脉（IRA）的TIMI血流分级、术前及术后各导联ST段抬高的平均值、术后ST段回落程度及住院期间心血管不良事件发生率。结果 高血糖组发病到就诊的时间长（P〈0．05），无痛性心肌梗死发生率及心血管不良事件发生率比正常血糖组高（P〈0．05）；两组PCI术后60min各导联ST段抬高平均值及术后ST段回落程度比较差异有统计学意义（P〈0．05）；高血糖组多支血管病变、弥漫性病变比例较正常血糖组高（P〈0．05），左室射血分数明显降低（P〈0．05）。结论 既往有糖尿病病史或入院后随机血糖升高的AMI患者，行急诊PCI治疗后的心肌灌注较差，进而影响心功能，增加住院期间心血管不良事件的发生率。Objective To investigate the influence of hyperglycemia on myocardial microcirculation reperfusion and prognosis in patients with acute myocardial infarction （AMI） after percutaneous coronary intervention （PCI）. Methods One hundred and six patients with AMI who underwent PCI were enrolled. The 106 patients were divided into 2 groups according to history of diabetes and the blood glucose level on admission：hyperglycemia group （n = 49） with blood glucose ≥7.8 mmol/L and normal glycemia group （n = 57 ） with blood glucose 〈 7.8 mmol/L. The average ST-segment elevation ,reduction between the two groups before and after PCI, clinical events and angiograpbic data were analyzed by statistics. Results Compared with the normal glycemia group,the time before hospital was longer （P 〈 0.05）,the incidence of non-chest pain and main adverse cardiovascular event （MACE） were higher （P 〈 0.05 ） in hyperglycemia group. The average ST-segment reductions after PCI were significandy higher in hyperglycemia group compared with those in normal glycemia group（P 〈 0.05 ）. The ST-segment reductions before and after PCI in hyperglycemia group were significandy lower compared with those in normal glycemia group （P 〈 0.05 ）. The patients in hyperglycemia group bad more 2-vessel or 3-vessel process （P 〈 0.05 ）. Left ventricular ejection function was significandy lower in hyperglycemia group （P 〈 0.05 ）. Conclusions Elevated glucose level on admission in AMI patients treated with primary PCI is associated with reduced myocardial microvascular flow. Abnormal myocardial microvascular flow might contribute to the poor outcomes observed in patients with hyperglycemia on admission.

关 键 词：心肌梗死 介入治疗 经皮冠状动脉 心电图 高血糖 

分 类 号：R542.22[医药卫生—心血管疾病]