缺血后适应对急性心肌梗死合并糖尿病患者临床及预后的影响.docVIP

·142 · GIP Chinese General Practice y2012.VoL No.IB ·论著 · 缺血后适应对急性心肌梗死合并糖尿病患者临床及预后的影响 张庆华，闰华，李莉，刘晓坤，赵碧琼，田美荣 【摘要】 目的 探讨心肌缺血后适应对急性心肌梗死 (AMI) 合并糖尿病患者临床及预后的影响。方法 选择 首次发生AMI 且合并糖尿病患者32例及AMI 不合并糖尿病患者35例，均于PCI 术中设置缺血后适应方式；对照组37 例 AMI 行常规 PCI术。测定3组术前及术后肌酸激酶 (CK) 及肌酸激酶同工酶 (CK-MB) 水平；测量术后3个月左 心室舒张期末容积指数 (LVEDVI)、 左心室收缩期末容积指数 (LVESVI)、 左心室射血分数 (LVEF); 观察术后严重 心律失常、梗死后心绞痛、住院期间病死率发生情况。结果 与常规治疗组比较，后适应组术后CK 及CK-MB 峰值 水平明显减低，术后3个月左心室容积减小；严重心律失常、梗死后心绞痛后适应组明显减低 (P0.05)。 且上述指 标在非糖尿病后适应组较糖尿病后适应组改善明显，差异有统计学意义 (P0.05)。3 组患者住院期间病死率间差异 无统计学意义 (P0.05)。 结论 心肌缺血后适应对AMI 心肌有保护作用，能改善患者预后，但对合并糖尿病AMI 患者保护作用减弱。 【关键词】 心肌缺血；心肌梗死；再灌注损伤；糖尿病；预后 【中图分类号】 R542.22 【文献标识码】 A 【文章编号】1007-9572(2012)01-0142-03 Cl inical and Prognosis Effect of Myocardial Ischemic on Acute Myocardial Infarction Patients with Diabetes Mellitus ZHANG Qing-hua,YAN Hua,LI Li,et al. Department of Cardiology, Tangshan Worhers Hospital, Tangshan 063000,Chi- na 【Abstract】 Objective To evaluate the effect of ischemic on clinical course and prognosis in patients with myocardial infarction accompanied diabetes mellitus during percutaneous coronary intervention. Methods A total of 104 enrolled patients with AMI were divided into three groups: 32 patients accompanied diabetes mellitus(group 1)and 35 patients without diabetes mellitus(group 2) were treated with PCI operation set schemic postconditioning way and 37 control patients with AMI(group 3) were treated with conventional PCI opetation. The level of plasma CK and CK-MB were detected before and after the operation. The indices of left ventricular end diastolic volume index(LVEDVI),left ventricular end systolic volume index(LVESVI)and left ventricular ejection fraction(LVEF) were measured by ultrasonic cardiogram three months after the onset of AMI. Malignant arrhythmia, angina occurred after AMI and death rate in hospital were compared among the three groups. Results The peak level of plasma CK and CK-MB were lower in PC group(group 1 and group 2)