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目的:观察入院时随机血糖对急性ST段抬高性心肌梗死患者直接冠状动脉介入术(PCI)后的心肌灌注的影响及预后价值。方法:对直接PCI治疗的182例资料完整的急性ST段抬高性心肌梗死患者进行了回顾性分析,根据患者入院后即刻的随机血糖分为3组:A组血糖<7.8mmol/L,B组血糖7.8～11.0mmol/L,C组血糖≥11.0mmol/L。评估PCI后TIMI血流分级及TMPG心肌灌注分级;发病后1周内行超声心动图检查测定左心室射血分数(LVEF),评价心脏收缩功能。结果:①冠状动脉造影结果中多支血管病变:C、B组(65.8%、63.6%)多于A组∶(49.4%,P<0.05);②PCI后梗死相关血管TIMI血流分级3级:3组无明显差异(89.9%、87.3%、89.5%,P>0.05);③PCI后心肌灌注分级(TMPG)0～1级:C、B组(28.9%、27.3%)高于A组∶(14.6%,P<0.05);④PCI后1周内超声心动图左室射血分数(LVEF值):C、B组[(49.6±7.0)%,(51.4±7.0)%低于A组∶(58.5±7.2)%,P<0.05]。结论:入院随机血糖高的急性ST段抬高性心肌梗死患者在介入治疗后的心肌灌注差、心功能差。
Objective: To observe the effect of random blood glucose on myocardial perfusion after PCI in patients with acute ST-segment elevation myocardial infarction on admission and its prognostic value. Methods: A retrospective analysis of 182 patients with complete ST-segment elevation acute myocardial infarction treated with direct PCI was conducted. According to the randomized blood glucose immediately after admission, the patients were divided into 3 groups: blood glucose <7.8mmol / L, B Group of blood glucose 7.8 ~ 11.0mmol / L, C group of blood glucose ≥ 11.0mmol / L. TIMI flow grade and TMPG myocardial perfusion grade were evaluated after PCI. Left ventricular ejection fraction (LVEF) was measured by echocardiography within 1 week after onset to evaluate cardiac systolic function. Results: ①Coronary artery angiography showed multi-vessel disease: more in group C and B (65.8%, 63.6%) than in group A (49.4%, P <0.05); (2) TIMI grade of infarction- (P> 0.05). ③ After myocardial perfusion grading (TMPG) of grade 0 ~ 1 in PCI group (C), B group (28.9%, 27.3%) was higher than that of A group (89.9%, 87.3%, 89.5% (49.6 ± 7.0)% and (51.4 ± 7.0)% respectively in group C and B were lower than those in group A (P <0.05); ④The left ventricular ejection fraction (EVE) 58.5 ± 7.2)%, P <0.05]. Conclusions: Myocardial perfusion is poor and cardiac function is poor after PCI in patients with acute ST-segment elevation myocardial infarction who are admitted to hospital.