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目的探讨急性心肌梗死(AMI)患者行冠状动脉介入治疗(PCI)后应激激素与血糖变化及其对预后的影响。方法对上海中医药大学附属普陀医院心内科2006年10月至2009年5月收治的115例非糖尿病AMI患者入院即刻血糖进行测定,将其分为无应激性高血糖组68例(A组)和应激性高血糖组(随机血糖≥7.8mmol/L)47例(B组),对比分析两组的临床资料和应激激素变化及30d内心力衰竭、再发心肌梗死、梗死后心绞痛、严重心律失常及心血管死亡情况。结果应激性高血糖的发生率为40.87%;B组应激激素(皮质醇、生长激素、胰高血糖素、ACTH)显著高于A组(P<0.01),而B组胰岛素显著低于A组(P<0.01);AMI急性期B组心力衰竭、再发心肌梗死、梗死后心绞痛、严重心律失常及心血管死亡情况均显著高于A组(P<0.05)。B组左心室射血分数[(49.97±7.21)%]显著低于A组[(54.03±6.34)%](P<0.05)。结论入院血糖与应激激素异常增高和AMI患者PCI术后30d内预后较差相关。
Objective To investigate the changes of stress hormones and blood glucose after coronary intervention (PCI) in patients with acute myocardial infarction (AMI) and its effect on prognosis. Methods 115 cases of non-diabetic patients with AMI who were admitted to Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from October 2006 to May 2009 were randomly divided into two groups: group A (n = 68) without stress hyperglycemia ) And stress hyperglycemia group (random blood glucose≥7.8mmol / L), 47 cases (group B). The clinical data and the changes of stress hormones and heart failure within 30 days in two groups were analyzed retrospectively. The incidences of myocardial infarction, , Severe arrhythmia and cardiovascular deaths. Results The incidence of stress hyperglycemia was 40.87%. The levels of stress hormones (Cortisol, growth hormone, glucagon, ACTH) in group B were significantly higher than those in group A (P <0.01), while those in group B were significantly lower than those in group B Group A (P <0.01); Group AMI acute heart failure, recurrent myocardial infarction, infarction angina pectoris, severe arrhythmia and cardiovascular death were significantly higher than Group A (P <0.05). The left ventricular ejection fraction (49.97 ± 7.21)% in group B was significantly lower than that in group A (54.03 ± 6.34%) (P <0.05). Conclusion The incidence of abnormal blood glucose and stress hormones and AMI patients within 30d after PCI related to poor prognosis.