胰岛素强化降糖治疗改善ACS伴高血糖患者预后的随访研究

摘要

Objective To investigate the intensive insulin therapy in patients with acute coronary syndrome (ACS) associated with the prognosis of patients with hyperglycemia,in order to improve the prognosis of patients with ACS associated with hyperglycemia in search of effective treating method.Methods280 cases of ACS patients were randomly divided into three groups,namely the intensive insulin therapy group (100 cases),insulin treatment group (90 cases),oral hypoglycemic drug group (90 cases). Each group had the same treatment using conventional ACS drugs.And recorded before treatment and hospitalization and discharged one days before the plasma glucose and left ventricular ejection fraction (LVEF).The follow-up time was scheduled for ACS after first months, third months and sixth month.ResultsThree groups of one days before discharge plasma glucose and LVEF were significantly improved(P<0.05),intensive insulin therapy group 1 day before discharge,plasma glucose level in 1 months,3 months,6 months [(6.53±1.55) were mmol/L,(6.88±1.64) mmol/L,(6.91±2.01)mmol/L,(6.96±1.78) mmol/L] were lower in insulin group and oral hypoglycemic drug group, between group the differences were statistically significant (P<0.05);intensive insulin therapy group 1D before discharge,1 months, 3 months, 6 months LVEF [(54.88±15.06)% was dis charged,(54.79±10.06)%,(53.52±12.25)%,(53.96±10.43)% were higher than that of in insulin group and oral sugar reducing medicine group,the differences between groups were statistically significant (P<0.05); intensive insulin group during the follow-up period of the two indicators of treatment had no significant change,but in insulin group and oral hypoglycemic drugs group shows a relapse tendency. Conclusion Insulin intensification therapy of ACS with high blood sugar,the hypoglycemic effect significantly,can significantly improve the heart function,It is worth of clinical application.%目的：探讨胰岛素强化降糖治疗对急性冠脉综合征（ACS）伴高血糖患者预后的影响，旨在针对ACS伴高血糖状态患者，寻找经济有效的治疗方法。方法将280例ACS患者按照随机数字表法分为三组，即强化胰岛素治疗组（100例）、胰岛素治疗组（90例）、口服降糖药组（90例）。每组均使用相同的常规ACS药物治疗。记录治疗前及住院治疗出院前1d的血浆葡萄糖和左心室射血分数（LVEF）。随访时间定于ACS后第1个月、第3个月和第6个月。结果三组出院前1d血浆葡萄糖及LVEF均显著改善（P均＜0.05），强化胰岛素治疗组出院前1d、出院1、3、6个月血浆葡萄糖水平[（6.53±1.55）mmol/L、（6.88±1.64）mmol/L、（6.91±2.01）mmol/L、（6.96±1.78）mmol/L]均低于胰岛素治疗组及口服降糖药组，组间比较差异均有统计学意义（P均＜0.05）；强化胰岛素治疗组出院前1d、出院1、3、6个月LVEF水平[（54.88±15.06）%、（54.79±10.06）%、（53.52±12.25）%、（53.96±10.43）%]均高于胰岛素治疗组及口服降糖药组，组间比较差异均有统计学意义（P均＜0.05）；随访期间强化胰岛素治疗组上述两个指标均无显著变化，但胰岛素治疗组及口服降糖药组呈现一定复发趋势。结论胰岛素强化降糖治疗ACS伴高血糖，获得了显著的降糖效果，明显改善了心功能，值得临床上推广应用。