本文選題：高血糖 + 急性心肌梗死��； 參考：《中國老年學(xué)雜志》2016年22期

【摘要】：目的觀察非糖尿病急性心肌梗死(AMI)患者的血糖水平與心臟復(fù)極活動的關(guān)系,并探討其對預(yù)后的影響。方法根據(jù)急性期(1~3 d)的空腹血糖(FPG)水平,入選無糖尿病的AMI患者186例,分為對照組(5.6~7.8 mmol/L)和高糖組(7.8 mmol/L),比較兩組患者的QT間期(QT)、校正后QT間期(QTc)、T波頂點到終點的時程(Tp Te)、QT間期Tp Te/QT和室性心律失常發(fā)生率的差異,運用相關(guān)性分析觀察血糖和心臟復(fù)極的關(guān)系,并進(jìn)行隨訪,比較兩組患者終點事件(再發(fā)心梗、因心力衰竭入院和死亡)的差異,并用Cox回歸分析觀察血糖與預(yù)后的關(guān)系。結(jié)果與對照組比較,高糖組患者的QTc〔(434.7±22.5)ms vs(412.9±21.3)ms〕、Tp Te〔(86.2±5.6)ms vs(75.2±4.1)ms〕、Tp Te/QT〔(0.22±0.05)ms vs(0.19±0.04)ms〕顯著延長(P0.05);頻發(fā)室性期前收縮和室速發(fā)生率顯著增加(P0.05),室顫發(fā)生率無顯著差異(P0.05);血糖水平與復(fù)極時程呈中度相關(guān)(P0.05);平均隨訪(12.4±3.6)個月,生存分析顯示高糖組患者終點事件發(fā)生率高于對照組(34.3%vs 20.2%,P=0.02),高血糖是預(yù)后的獨立危險因素(OR 3.75,95%CI:2.87~5.25,P0.01)。結(jié)論高血糖嚴(yán)重影響非糖尿病AMI患者的心電活動和預(yù)后,降糖治療有望改善患者的臨床結(jié)局。
[Abstract]:Objective to investigate the relationship between blood glucose level and cardiac repolarization in patients with non-diabetic acute myocardial infarction (AMI). Methods according to the fasting blood glucose level of 3 days in the acute phase, 186 patients with AMI without diabetes mellitus were enrolled. The patients were divided into two groups: control group (5.6nmol / L) and high glucose group (7.8mmol / L). The QT interval (QT interval), the corrected QT interval and the time course from the top of QT interval to the end point of T wave, and the incidence of ventricular arrhythmias were compared between the two groups. The relationship between blood glucose and cardiac repolarization was observed by correlation analysis and followed up to compare the difference of end point events (recurrent myocardial infarction, hospitalization and death due to heart failure) between the two groups, and the relationship between blood glucose and prognosis was observed by Cox regression analysis. Results compared with the control group, In high glucose group, QTc((434.7 鹵22.5)ms vs(412.9 鹵21.3 QTc((434.7 Te((86.2 鹵5.6)ms vs(75.2 鹵4.1 Te((86.2 鹵4.1 Te((86.2 鹵4.1T Te/QT((0.22 鹵0.05)ms vs(0.19 鹵0.04 Ms) significantly prolonged P0.05, and the incidence of frequent premature ventricular contraction and ventricular tachycardia increased significantly (P0.05), and there was no significant difference in incidence of ventricular fibrillation (P0.05). The blood glucose level was moderate to that of repolarization process (P < 0.05), and the incidence of frequent ventricular premature contraction and ventricular tachycardia increased significantly (P < 0.05), but the incidence of ventricular fibrillation was not significantly different from that in hyperglycemia group. The average follow-up was 12.4 鹵3.6 months. Survival analysis showed that the incidence of endpoint events in the high glucose group was higher than that in the control group (34. 3 vs 20. 2). Hyperglycemia was an independent risk factor for prognosis. Conclusion hyperglycemia seriously affects the ECG activity and prognosis of patients with non-diabetic AMI, and hypoglycemic therapy is expected to improve the clinical outcome of patients with non-diabetic AMI.
【作者單位】： 華中科技大學(xué)同濟醫(yī)學(xué)院附屬普愛醫(yī)院ICU科;
【分類號】：R542.22

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