【摘要】：目的探討老年經皮冠狀動脈介入手術(PCI)患者血糖水平與心肌灌注及不良心臟事件的關系。方法接受PCI再灌注治療的急性ST段抬高型心肌梗死(STEMI)患者394例,根據(jù)患者的血糖水平分成對照組(血糖水平7.0 mmol/L)136例及血糖上升組(血糖水平7.0~11.1 mmol/L)148例、高血糖組(血糖水平11.1 mmol/L)110例。對比各組PCI術后的心肌灌注和心功能指標,隨訪6個月,記錄患者的不良心臟事件發(fā)生情況,Logistic回歸分析評價影響PCI術后不良心臟事件的危險因素。結果血糖上升組與高血糖組肌酸激酶同工酶(CK-MB)峰值明顯高于對照組,左室射血分數(shù)(LVEF)水平、ST段回落較好及心肌灌注的血流分級(TMPG)2~3級的比例明顯低于對照組,高血糖組CK-MB峰值明顯高于血糖上升組,LVEF水平明顯低于血糖上升組(均P0.05)。394例患者PCI術后發(fā)生不良心臟事件者62例(15.74%)。PCI術后發(fā)生不良心臟事件者存在應激性高血糖(SHG)、TMPG 0~1級、吸煙及泵衰竭≥Ⅱ級的比例均分別明顯高于未發(fā)生不良心臟事件者(均P0.05),且Logistic回歸分析顯示,上述4個指標均是影響PCI術后不良心臟事件的危險因素。結論老年PCI患者的血糖水平與其心肌灌注以及不良心臟事件之間均存在緊密聯(lián)系,存在SHG、TMPG 0~1級、吸煙以及泵衰竭≥Ⅱ級會增加PCI術后不良心臟事件發(fā)生風險。
[Abstract]:Objective to investigate the relationship between blood glucose level and myocardial perfusion and adverse cardiac events in elderly patients undergoing percutaneous coronary intervention (PCI). Methods A total of 394 (STEMI) patients with acute ST segment elevation myocardial infarction were treated with PCI reperfusion. According to the blood glucose level of the patients, there were 136cases in the control group (7.0mmol/L), 148cases in the elevated blood glucose group (7.0x11.1 mmol/L), and 110 cases in the hyperglycemia group (11.1 mmol/L). The indexes of myocardial perfusion and cardiac function after PCI were compared in each group. The adverse cardiac events were recorded after 6 months of follow-up. The risk factors of adverse cardiac events after PCI were evaluated by Logistic regression analysis. Results the peak value of creatine kinase isoenzyme (CK-MB) in hyperglycemia group and hyperglycemia group was significantly higher than that in control group. Left ventricular ejection fraction (LVEF) (LVEF) level was significantly higher than that in control group. The percentage of blood flow grade (TMPG) 2 / 3 in myocardial perfusion group was significantly lower than that in control group, and the peak value of CK-MB in hyperglycemia group was significantly higher than that in hyperglycemia group. The level of LVEF was significantly lower than that of the elevated blood glucose group (all P0.05). There were 62 cases (15.74%) with adverse cardiac events after PCI (15.74%) with stress hyperglycemia (SHG), TMPG 0 grade 1, and there was no significant difference between the two groups (P < 0.05). The rates of smoking and pump failure grade 鈪，

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