【摘要】 目的通过主动干预急性心肌梗死(AMI)患者应激性高血糖,研究应激期保持一定范围血糖值,对经皮冠状动脉介入(PCI)干预的AMI患者的近期预后的影响。方法随机将入院即刻血糖≥12.0 mmol/L患者分为干预组和对照组。干预组给予普通胰岛素皮下注射或静脉泵入维持血糖值在7.8~11.1 mmol/L之间。比较2组患者随机血糖、血糖恢复至7.8~11.1 mmol/L时间、住院平均血糖、住院时间、再发AMI、严重心律失常、充血性心衰、心源性休克、心脏彩色多普勒超声检测EF斜率≥35%人数;入、出院时KillipⅡ~Ⅲ级及死亡人数。结果干预组血糖值恢复至预定值时间、平均血糖值、住院时间、严重心律失常、充血性心衰、死亡及出院时KillipⅡ~Ⅲ级人数等都低于对照组,EF斜率≥35%人数显著高于非干预组(P<0.05,<0.01)。Logistic回归分析,死亡事件与严重心律失常(P=0.001,OR=1.225)、住院平均血糖值(P=0,OR=0.123)密切相关。结论急诊PCI不能改变应激高血糖引起的心肌的病理生理改变。主动干预急性心肌梗死患者应激期高血糖,有利于PCI干预的患者的近期预后。更多还原

【Abstract】 Objective To research the effect of active intervention on stress hyperglycemia on recent prognosis of the patients with acute myocardial infarction( AMI) undergoing percutaneous coronary intervention( PCI). Methods The patients with a high level of blood glucose( ≥12. 0 mmol / L) at admission were selected and randomly divided into intervention group and control groups. The level of blood glucose of patients in the intervention group was maintained between 7. 8and 11. 1 mmol / L by regular subcutaneous injection or infusion of insulin with a pump. The random blood glucose,the time for blood glucose levels returned to between 7. 8 and 11. 1 mmol / L,the average blood glucose levels during hospitalization,the average length of stay,cases with recurrent myocardial infarction,severe arrhythmia,congestive heart failure,cardiogenic shock,EF slope≥35% by cardiac color Doppler ultrasound detection,the cases with Killip grade Ⅱ-Ⅲ at admission and discharge,and death cases were compared between the both groups. Results In the intervention group,the time for blood glucose levels returned to between 7. 8 and 11. 1 mmol / L and the average duration of hospitalization were shorter,the average blood glucose level was lower,the cases with severe arrhythmia,congestive heart failure,Killip gradeⅡ-Ⅲ during discharge and death were less. The cases with EF slope≥35% was significantly higher than as compared to the control group( P < 0. 05,< 0. 01). Logistic regression analysis showed that deaths were closely related to the occurrence of serious arrhythmias( P = 0. 001,OR = 1. 225) and mean blood glucose levels during hospitalization( P = 0,OR =0. 123). Conclusion The pathophysiological changes of myocardial induced by stress hyperglycemia cannot be changed by PCI in emergency. Active intervention of blood glucose is beneficial for the recent prognosis of the patients undergoing PCI,which should reduce the adverse events and improve the quality of life of patients.更多还原