强化血糖控制对急性心肌梗死合并应激性高血糖患者的预后影响  

Effect of intensive blood glucose control in patients with acute myocardial infarction complicated with hyperglycaemia

作　　者：贾志[1,2] 郭牧[2] 宋昱[2] 张云强[2] 梁海青[2] 

机构地区：[1]天津医科大学研究生院,天津300070 [2]泰达国际心血管病医院CCU,天津300457

出　　处：《重庆医学》2012年第10期954-955,958,共3页Chongqing medicine

摘　　要：目的探讨强化血糖控制能否给急性心肌梗死(AMI)合并应激性高血糖患者带来更大益处。方法将224例AMI合并应激性高血糖入院患者随机分为两组,分别给予常规降糖治疗组(A组)和强化降糖治疗组(B组),比较院内不良事件及6个月随访情况。结果两组治疗后空腹血糖均逐渐下降,B组于治疗24、72h、1周时空腹血糖均低于A组。在院期间B组心绞痛及严重心律失常均少于A组(P=0.038、P=0.021),但低血糖反应较A组增多(P=0.032);再梗死、心力衰竭、院内死亡及心脏主要不良事件两组差异无统计学意义(P>0.05)。6个月内随访,心绞痛、心肌梗死、全因死亡及再住院两组差异均无统计学意义(P>0.05)。结论 AMI合并应激性高血糖的患者采用强化血糖控制早期仍有临床意义,但远期无明显获益。Objective To investigate the clinical effectiveness of intensive blood glucose control in acute stage of patients with acute myocardial infarction（AMI） complicated with hyperglycaemia.Methods 224 non-diabetic patients with AMI accompanied by hyperglycaemia were randomly divided into 2 groups：conventional treatment group and intensive control group,which respectively received conventional controls and tight controls of blood glucose.The clinical effectiveness was compared between the groups.Results The fasting blood glucose remained reduced at various time points in both groups,however,the intensive control group got lower.Angina and malignant arrhythmia rate in intensive control group were lower than those in conventional treatment group（15.9% vs 27.4%,40.2% vs 55.6%,P=0.038 and 0.021,respectively）,while hypoglycemia rate increased in intensive control group（15.9% vs 6.8%,P=0.032）.For re-infarction,heart failure,mortality and major adverse cardiac events,no statistical difference was found between the two groups（P0.05）.During 6 months follow-up period,no statistical diference was found in angina,myocardial infarction,total mortality and re-hospitalization（P0.05）.Conclusion Hospitalization insuline intensification therapy could raise therapeutic effect on AMI complicated with hyperglycaemia.

关 键 词：心肌梗死 应激性高血糖 胰岛素治疗 预后 

分 类 号：R542.22[医药卫生—心血管疾病]