强化血糖控制对糖尿病伴急性心肌梗死患者经皮冠状动脉介入治疗术后心肌组织灌注及心室功能的影响  

Effects of intensive glucose control on myocardial tissue perfusion and ventricular function in post-percuta. neous coronary intervention diabetes mellitus patients with acute myocardial infarction

作　　者：孙云香[1] 

机构地区：[1]山东省日照市人民医院内分泌科,276826

出　　处：《中国医药》2011年第5期552-554,共3页China Medicine

摘　　要：目的观察强化血糖控制对糖尿病伴急性心肌梗死（AMI）患者经皮冠状动脉介入治疗（PCI）术后心肌组织灌注及心室功能的影响。方法68例2型糖尿病伴AMI患者完全随机分为糖尿病常规治疗组（34例）和糖尿病强化治疗组（34例），并以69例糖耐量正常NGT的AMI患者为NGT对照组。常规治疗为诺和灵30R皮下注射，维持血糖在8．0—11．1mmol／L；强化治疗为静脉滴注胰岛素和（或）胰岛素泵治疗，维持血糖在4．4—6．1mmol／L。所有患者均于发病后24h内行PCI，治疗后行心肌呈色分级（MBG），评价心肌微循环灌注情况，并于术后1周及1个月行心脏超声心动图检查，分别测定左心室射血分数、心指数，评价心室功能。结果3组患者PCI术后心肌梗死溶栓试验（TIMI）3级的比率差异无统计学意义（P〉0．05），糖尿病常规治疗组和糖尿病强化治疗组患者MBG2～3级比例均明显低于NGT对照组（64．7％，82．3％比94．2％，均P〈0．01），PCI术后1周和1个月时睹尿病强化治疗细心指数明显高于糖尿病常规治疗组[（3．17±0．42）L／（min·m2）比（2．62±0．43）L／（min·m2），（3．85±0．51）L／（min·m2）比（3．14±0．57）L／（min·m2），P〈0．05]，而糖尿病强化治疗组心指数和NGT对照组间差异无统计学意义（P〉0．05）；3组患者术后1周与术后1个月比较心指数均改善且差异有统计学意义（均P〈0．05）；NGT对照组左心室射血分数高于糖尿病常规治疗组和糖尿病强化治疗组（P〈0．01），PCI术后1个月NGT对照组和糖尿病强化治疗组左心室射血分数较术后1周时明显改善（P〈0．05），糖尿病常规治疗组亦有一定改善，但差异无统计学意义。结论强化血糖控制可明显改善糖尿病伴AMI患者急诊PCI术后的心肌组织灌注及心室功能。Objective To examine the effects of intensive glucose control on myocardial tissue perfusion and ventrlcular function in post-percutaneous coronary intervention（PCI） diabetes mellitus（DM） patients with acute myocardial infarction（AMI）. Methods Sixty-eight DM patients with AMI were divided into two groups： DM rou- tine treatment group（ n = 34 ） and DM intensive treatment group（ n = 34 ）, and 69 AMI patients with normal glucose tolerance （NGT） as NGT control group. DM routine treatment group were treated with novolin 30R, to maintain blood glucose in 8.0- 11.1 retool/L; DM intensive treatment group were treated with insulin, and（or） insulin pump, to maintain blood glucose in 4.4 ~ 6. 1 mmol/L. All patients underwent emergency coronary angiography af- ter PCI. We estimated the myocardial tissue perfusion according to the myocardial blush grade（MBG）. The left ven- trlcular ejection fraetio（LVEF） and cardiac index（CI） were measured in all patients at 1 week and 1 month after PCI to estimate ventricular function. Results There was no significant difference in TIMI Grade 3 after PCI among three groups（P 〉0.05 ） , and the percentage of efficient reperfusion in DM group was significantly lower than NGT control groups（04.7% ,82.3% vs 94.2% , P 〈0. O1 ）. The CI value was much higher in NGT intensive treatment group than DM routine treatment group（ P 〈 0.01 ）, and there was no significant difference between DM intensive treatment group and NGT control group at 1 week and 1 month after PCI （P 〉 0. 05）, but the CI value was signifi- cantly improved in all three groups at 1 month than at 1 week after PCI（P 〈0.05）. The LVEF was much higher in NGT control group than DM groups（p 〈0.01 ） , and significantly improved in NGT control group and DM intensive treatment group at 1 month than at 1 week after PCI（P 〈0.05） ,but there was no significant improved in DM routine treatment group（P 〉 0. 05 ）. Conclusion Intensive glucose control may significa

关 键 词：糖尿病 血管成形术 经腔 经皮冠状动脉 心肌梗死 

分 类 号：R654.2[医药卫生—外科学]