急性心肌梗死患者行急诊经皮冠状动脉介入术后ST段回落与高血糖的关系Relation between ST-segment reduction and hyperglycemia in patients with acute myocardial infarction treated with emergent PCI
徐援,常宇锋,杨中苏,闫慧,王攀,杨新春
摘要(Abstract):
目的 探讨急性心肌梗死 (AMI)患者行急诊经皮冠状动脉介入术 (PCI)后ST段回落与血糖的关系。方法 入选AMI患者 80例 ,急诊入院后 90min内行冠状动脉造影示梗死相关血管前向血流TIMI 0到 1级 ,PCI后梗死相关血管前向血流TIMI恢复到 3级。术前常规心电图、生化与cTnI检查及抗栓治疗。术后 0 5h行心电图检查 ,1周后复查心电图。按血糖水平分为两组 :血糖 <8 8mmol/L(16 0mg/dl)为Ⅰ组 (41例 ) ,血糖≥ 8 8mmol/L(16 0mg/dl)为Ⅱ组 (39例 )。比较两组术前、术后及 1周时各导联ST段抬高的平均值及术前、术后ST段回落程度 ,并对其进行统计学分析。结果 Ⅱ组与Ⅰ组相比 ,术后及 1周时各导联抬高的ST段平均值及术前、术后ST段回落程度差异有显著性 ,患者既往是否有糖尿病其差异也有显著性。结论 急性心肌梗死再灌注治疗后心电图抬高的ST段回落程度受高血糖的影响。高血糖可能通过激活炎症及凝血系统 ,影响心肌的微循环灌注。
关键词(KeyWords): 急性心肌梗死;心电描记术;血糖
基金项目(Foundation):
作者(Author): 徐援,常宇锋,杨中苏,闫慧,王攀,杨新春
参考文献(References):
- 1ItoH ,MaruyamaA ,IwakuraK ,etal.Clinicalimplicationsofthe‘no reflow’phenomenonapredicatorofcomplicationsandleftventricularremodelinginreperfusedanteriorwallmyocardialinfarction.Circulation,1996,93:223228.
- 2BarbashGI,RothA ,HodH ,etal.RapidresolutionofSTelevationandpredictionofclinicaloutcomeinpatientsundergoingthrombolysiswithalteplase(recombinanttissue typeplasminogenactivator):resultsoftheIsraeliStudyofEarlyInterventioninMyocardialInfarction.BrHeartJ ,1990,64:241247.
- 3SantoroGM ,ValeniR ,BuonamiciP ,etal.RelationbetweenST segmentchangesandmyocardialperfusionelevatedbymyocardialcontrastechocardiographyinpatientswithacutemyocardialinfarctiontreatedwithdirectangioplasty.AmJCardiol,1998,82:932937.
- 4MarfellaR ,EspositoK ,GiuntaR ,etal.Circulatingadhesionmoleculesinhumans:roleofhyperglycemiaandhyperinsulinemia.Circulation,2000,101:22472251.
- 5EnglerRL ,DahlgrenMD ,MorrisDD ,etal.Roleofleukocytesinresponsetoacutemyocardialischemiaandreflowindogs.AmJPhysiol,1986,251:H314323.
- 6MontalescotG ,BarraganP ,WittenbergO ,etal.PlateletglycoproteinⅡb/Ⅲainhibitionwithcoronarystentingforacutemyocardialinfarction.NEnglJMed,2001,344:18951903.
- 7ShechterM ,MerzCN ,PaulLabradorMJ,etal.Bloodglucoseandplatelet dependentthrombosisinpatientswithcoronaryarterydisease.JAmCollCardiol,2000,35:300307.
- 8KerstenJR ,TollerWG ,TessmerJP ,etal.Hyperglycemiareducescoronarycollateralbloodflowthroughanitricoxide mediatedmechanism.AmJPhysiolHeartCircPhysiol,2001,281:H20972104.
- 9YaromR ,ZirkinH ,StammerG ,etal.Humancoronarymicrovesselsindiabetesandcoronaryvasodialationinpatientswithdiabetesmellitus.Circulation,1995,91:635.
- 10KerstenJR ,SchmelingTJ ,OrthKG ,etal.Acutehyperglycemiaabolishesischemicpreconditioninginvivo.AmJPhysiolHeartCircPhysiol,1998,275:H721725.
- 11KerstenJR ,MontogomeryMW ,GhassemiT ,etal.DiabetesandhyperglycemiaimpairactivationofmitochondrialKATPchannels.AmJPhysiolHeartCircPhysiol,2001,280:H17441750.
- 12McDonaghPH ,HokamaJY ,CopelandJG ,etal.Thebloodcontributiontoearlymyocardialperfusioninjuryinamplifiedindiabetes.Diabetes,1997,46:18591867.
- 13NeumannFJ ,BlasiniR ,SchmittC ,etal.EffectsofglycoproteinⅡb/Ⅲareceptorblockadeonrecoveryofcoronaryflowandleftventricularfunctionaftertheplacementofcoronary arterystentsinacutemyocardialinfarction.Circulation,1998,98:26952701.