早期介入治疗对急性心肌梗死合并糖尿病患者心功能及心脏事件的影响研究

摘要

Objective To investigate the impact of early PCI on cardiac function and cardiac events in acute myocardial infarction patients complicated with diabetes. Methods From June 2012 to June 2013,a total of 120 acute myocardial infarction patients complicated with diabetes were selected in Hu'nan Provincial People's Hospital,and they were divided into A group(receiving PCI within 6 hours after attack,n = 56)and B group(receiving PCI between 6 and 12 hours after attack,n = 64)according to receiving PCI time,patients of both groups received aspirin and clopidogrel after PCI. Color Doppler blood flow detector was used to detect ventricular septal thickness(IVST),left ventricular ejection fraction(LVEF), left ventricular end diastolic diameter(LVDD),left ventricular end systolic diameter(LVSD)after 1 week of admission and after 1 year of discharge,incidence of cardiac events during hospital stay and follow - up(6 to 12 months) was recorded. Results No statistically significant differences of IVST,LVEF,LVDD or LVSD was found between the two groups before treatment(P > 0. 05);after treatment,IVST,LVDD and LVSD of A group were statistically significantly lower than those of B group,while LVEF of A group was statistically significantly higher than that of B group(P < 0. 05). During hospital stay,the incidence of recurrent myocardial infarction,recurrent angina pectoris,arrhythmia,composite outcomes events of A group was statistically significantly lower than that of B group respectively( P < 0. 05);during follow - up,the incidence of recurrent myocardial infarction,recurrent angina pectoris,arrhythmia,heart failure - induced,composite outcomes events and fatality rate of A group was statistically significantly lower than that of B group respectively(P < 0. 05). Conclusion Early PCI can effectively improve the cardiac function and reverse the ventricular remodeling of acute myocardial infarction patients complicated with diabetes,reduce the incidence of recent and long - term cardiac events,is helpful to improve the patients'prognosis.%目的：探讨早期介入治疗对急性心肌梗死（AMI）合并糖尿病患者心功能及心脏事件的影响。方法选择2012年6月—2013年6月湖南省人民医院收治的 AMI 合并糖尿病患者120例，根据患者行冠状动脉介入治疗（PCI）时机分为早期介入治疗组56例及晚期介入治疗组64例。早期介入治疗组患者于发病6 h 内行 PCI，晚期介入治疗组患者于发病6～12 h 内行 PCI，术后均给予阿司匹林联合氯吡格雷治疗。两组患者分别于入院后1周及出院后1年采用彩色多普勒血流仪测定舒张期室间隔厚度（IVST）、左心室射血分数（LVEF）、左心室舒张末期内径（ LVDD）、左心室收缩末期内径（LVSD），记录两组患者住院期间及随访期间（6～12个月）心脏事件发生情况。结果治疗前两组患者 IVST、LVEF、LVDD 及 LVSD 比较，差异无统计学意义（ P ＞0.05）；治疗后早期介入治疗组患者 IVST、LVDD 及 LVSD 小于晚期介入治疗组，LVEF 高于晚期介入治疗组（P ＜0.05）。住院期间早期介入治疗组患者再发心肌梗死、再发心绞痛、心律失常、心力衰竭、复合终点事件发生率低于晚期介入治疗组，随访期间早期介入治疗组患者再发心肌梗死、再发心绞痛、心律失常、心力衰竭、复合终点事件发生率及病死率低于晚期介入治疗组（ P ＜0.05）。结论早期介入治疗能有效改善 AMI 合并糖尿病患者心功能、逆转患者心室重构，降低患者近期及远期心脏事件发生率，有利于改善患者预后。