CAJ | 학술논문

目的观察入院时随机血糖对老年急性ST段抬高心肌梗死急诊经皮冠状动脉介入治疗(PCI)患者心功能及术后1年病死率的影响.方法对284例急诊PCI的老年急性ST段抬高心肌梗死患者的资料进行回顾性分析.根据入院后即刻的随机血糖,将患者分为3组:A组(血糖<7.8mmol/L)、B组(血糖7.8～10.9 mmol/L)及C组(血糖≥11.0 mmol/L).结果 (1)与A组比较,B组、C组患者女性所占比例较高(分别为26.5%比33.3%、40.2%,均P<0.01),平均住院时间较长(分别为13.9 d比16.0 d、16.6 d,均P<0.05).C组有高血压病史患者的比例高于A组(72.1%比54.9%,P<0.01).(2)急诊PCI后,合并高血糖的B组、C组患者TIMI心肌灌注分级(TMPG)0～1级所占比例高于血糖正常的A组(分别为22.6%、34.1%比13.3%,均P<0.05),TMPG达3级所占比例低于A组(分别为74.3%、57.6%比84.4%,均P<0.05).C组术中并发症发生率高于A组及B组(分别为42.5%比20.6%、26.6%,均P<0.01),术中应用主动脉内球囊反搏比例高于A组及B组(分别为19.5%比4.9%、6.4%,均P<0.01).(3)C组心功能Killip分级≥2级患者所占比例明显高于A组及B组(分别为44.8%比23.5%、27.7%,均P<0.01).与A组比较,C组患者住院期间病死率(8.0%比1.1%,P<0.05)及术后1年病死率(18.7%比3.4%,P<0.05)较高.结论合并高血糖的老年急性ST段抬高心肌梗死患者急诊PCI术后心肌组织水平灌注、心功能及预后均较差.
목적 관찰입원시수궤혈당대노년급성ST단태고심기경사급진경피관상동맥개입치료(PCI)환자심공능급술후1년병사솔적영향.방법 대284례급진PCI적노년급성ST단태고심기경사환자적자료진행회고성분석.근거입원후즉각적수궤혈당,장환자분위3조:A조(혈당<7.8mmol/L)、B조(혈당7.8～10.9 mmol/L)급C조(혈당≥11.0 mmol/L).결과 (1)여A조비교,B조、C조환자녀성소점비례교고(분별위26.5%비33.3%、40.2%,균P<0.01),평균주원시간교장(분별위13.9 d비16.0 d、16.6 d,균P<0.05).C조유고혈압병사환자적비례고우A조(72.1%비54.9%,P<0.01).(2)급진PCI후,합병고혈당적B조、C조환자TIMI심기관주분급(TMPG)0～1급소점비례고우혈당정상적A조(분별위22.6%、34.1%비13.3%,균P<0.05),TMPG체3급소점비례저우A조(분별위74.3%、57.6%비84.4%,균P<0.05).C조술중병발증발생솔고우A조급B조(분별위42.5%비20.6%、26.6%,균P<0.01),술중응용주동맥내구낭반박비례고우A조급B조(분별위19.5%비4.9%、6.4%,균P<0.01).(3)C조심공능Killip분급≥2급환자소점비례명현고우A조급B조(분별위44.8%비23.5%、27.7%,균P<0.01).여A조비교,C조환자주원기간병사솔(8.0%비1.1%,P<0.05)급술후1년병사솔(18.7%비3.4%,P<0.05)교고.결론 합병고혈당적노년급성ST단태고심기경사환자급진PCI술후심기조직수평관주、심공능급예후균교차.
Objective To investigate the association between hyperglycemia and outcome in elderly patients with acute ST segment elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention(PCI).Methods This retrospective analysis was performed on 284 elderly patients (age ≥ 60 years) with acute STEMI underwent primary PCI between January 2000 to April 2004 in our department.Patients were divided into 3 groups according to the level of blood glucose on admission: group A,<7.8 mmol/L;group B,7.8-10.gmmol/L;groupC,≥11.0mmol/L.Results (1)The proportion of female in group B and group C was greater than that of group A (33.3% vs.26.5% ,P<O.01 ;40.2% vs.26.5%,P < 0.01).The hospital stay time of group B and group C was significantly longer than that of group A (16.0 days vs.13.9 days,P <0.05;16.6 days vs.13.9 days,P < 0.05).There were more patients with history of hypertension in group C than that in group A(72.1% vs.54.9% ,P <0.01).(2) After PCI,the proportion of patients with TIMI myocardial perfusion grade (TMPG) 0-1 in group B and C was greater than that of group A (22.6% vs.13.3%,P < 0.05 ; 34.1% vs.13.3%,P < 0.05).The proportion of patients with TMPG 3 in group B and C was less than that in group A (74.3% vs.84.4% ,P <0.05; 57.6% vs.84.4% ,P <0.05).The complication rate of PCI was significantly higher in group C than in groupA(42.5% vs.20.6%,P<0.01)and groupB(42.5% vs.26.6%,P<0.01).IABP use was significantly more in group C than that in group A (19.5% vs.4.9% ,P<0.01)and group B(19.5% vs.6.4% ,P<0.01).(3)There were more patients with grade of Killip class ≥2 in group C than that in group A(44.8% vs.23.5%,P<0.01)and group B(44.8% vs.27.7%,P<0.01).The in-hospital mortality rate (8.0% vs.1.1% ,P<0.05)and one-year mortality rate(18.7% vs.3.4%,P<0.05) of group C were significantly higher than those in group A.Conclusion Hyperglycemia at admission was associated with poor tissue perfusion,cardiac function and prognosis in elderly patients with acute STEMI underwent primary PCI.