急诊PCI对糖尿病急性心肌梗死患者预后影响的研究

目的探讨对糖尿病合并急性心肌梗死（AMI）急诊经皮冠状动脉介入治疗（PcI）的近期疗效及并发症。方法选择接受急诊PCI的糖尿病合并急性sT段抬高型AMI（STEMI）患者133例（A组），非糖尿病AMI患者296例（对照组，B组）为研究对象。分别对两组的临床资料、冠状动脉病变特征、住院时间和并发症的发生率进行比较。结果两组患者性别、年龄、吸烟史、肾功能、高血压、高脂血症、既往PCI史、梗死前心绞痛和冠心病家族史差异均无统计学意义（P〉O．05）。糖尿病组单支病变发生率显著低于对照组（P〈0．01），双支、三支及合并左主干病变显著高于对照组（尸〈0．01）。两组急诊PCI处理的靶血管差异无统计学意义（Jp〉0．05）。PCI术前TIMI血流0--1级者组间差异无统计学意义（P〉0．05），PCI术后糖尿病组TIMI3级血流者显著少于对照组（P〈O．01）；TMPG分级0-1级和2级者显著多于对照组（P〈0．01），TMPG3级者显著少于对照组（P〈0．01）。两组间人院到球囊扩张平均时间、支架内血栓和30d病死率差异无统计学意义（P〉0．05）。糖尿病组平均住院时间、急诊PCI置入2个以上支架数、住院期间择期二次PCI、梗死后心绞痛、住院期间再梗死、严重心律失常、KillipIll级以上心功能和心源性休克的发生率显著高于对照组（尸〈0．05）。结论糖尿病合并AMI患者多支血管病变多见，PCI术后TIMI血流和TMPG低，恶性心律失常、心力衰竭、心源性休克等严重并发症多。

Effect of emergency PCI on prognosis in diabetes patients with acute myocardial infarction

Objective To study the therapeutic effect and safety of emergency percutaneous coronary in- tervention （PCI） in diabetes patients with acute myocardial infarction （AMI）. Methods This observational analysis was performed on one hundred and thirty-three diabetes （group A） and two hundred and ninety-six non-diabetes patients （group B） with AMI underwent emergency PCI in our department during January 2010 to October 2012. Their clinical data , coronary angiographic characteristics, hospital stay time and complications were respectively compared between two groups. Results There were no significant differences of sex, years of age, smoking, serum creatinine, the morbidity of hypedipemia and hypertension, past PCI, angina peetoris before MI and family history of coronary heart disease between two groups （P〉0.05）. The incidence of single vessel lesion in diabetes patients were significantly lower while the incidence of double vessel lesion, triple vessel lesion and involving left main coronary artery were significantly higher in diabetes patients than in non-diabetes patients （P〈0.01）. There were no significant differences of treated vessel lesion and the blood stream of coronary thrombolysis in myocardial infarction trial （TIMI） grade 0-1 between two groups before PCI（P〉O.05）. The blood stream of TIMI grade 3 in non-diabetes patients was significantly higher than in diabetes patients after emergencr PCI （P〈0.01）. The porprotion of patients with TIMI myocardial perfusion grade （TMPG） 0-1 in non-diabetes patients was significantly lower than in diabetes patients, while porprotion of patients with TMPG 3 in non-diabetes patients was significantly higher than in dia- betes patients after emergency PCI（P〈0.01）. There were no significant differences of average time from admission to balloon dilation,acute, and sub-acute thrombus in stent and 30-days mortality between two groups （P〉0.05）. The hospital stay time and number of patients who underwent implantation of more than two stents , second PCI, and the incidence of angina pectoris after MI , recurrent MI, severe arrthymia , heart failure ~〉Killip III and cardiogenic shock in diabetes patients were significantly higher than in non-diabetes patients（P〈0.05）. Conclusion Compared with non-diabetes patients with AMI ,there are double more than vessel lesion and involving left main artery in di- abetes patients with AMI, there less grade of blood stream of TIMI and TMPG, and there more severe arrthymia , heart failure〉 KiUipIII , cardiogenic shock in diabetes patients after emergencr PCI.