合并糖尿病的老年女性急性心肌梗死患者发病早期治疗现状分析

目的探讨老年女性急性心肌梗死早期合并糖尿病患者的治疗现状。方法回顾性分析168例患者,按照治疗方法不同将患者分为3组,溶栓组24例,经皮冠状动脉介入治疗(PCI)组45例,非再灌注组99例。登记患者的临床资料,包括年龄、发病时间、症状典型否、既往史、心肌梗死部位、Killip分级、临床药物使用情况及相关检验结果。登记住院期间及出院6个月心性不良事件发生情况。结果58.9%的患者接受了非再灌注治疗,少部分患者接受了溶栓(14.3%)和介入治疗(26.8%)。3组间的病死率无显著性差异;非再灌注组慢性心力衰竭发生率(住院44.1%,出院随访6个月38.2%)高于PCI组(住院13.3%,出院随访6个月13.3%)和溶栓组(住院22.2%,出院随访6个月11.1%,P<0.05)。循证医学证实有效的药物使用率最低的是氯吡格雷或噻氯匹定,仅24.4%。糖化血红蛋白控制不理想;低密度脂蛋白胆固醇>2.6 mmol/L的患者占74.5%。结论合并糖尿病的老年女性急性心肌梗死患者在发病早期应加强再灌注治疗。应加强低密度脂蛋白胆固醇及糖尿病的控制。

Analysis of early treatment of acute myocardial infarction in old female patients with diabetes

Objectives To investigate the current early treatment of the old female patients with acute myocardial infarction and diabetes and to evaluate which therapy is effective.Methods Retrospective analysis of 168 cases was carried out.They were divided into percutaneous coronary intervention(PCI) group(n=45),fibrinolytic group(n=24)and no reperfusion group(n=99) according to the different therapy methods.Patients′ clinical data,including age,disease onset time,Killip class,typical symptoms,past history,myocardial infarction region,drugs used,related test results,and in-hospital and out-hospital adverse cardiac events were recorded.Results 26.8%,14.3% and 58.9% patients received PCI,fibrinolysis and no reperfusion therapy respectively.There was no significant difference in the mortality between the three groups.The incidence of chronic heart failure in no reperfusion group(44.1% in hospital,38.2% within 6 months of follow up) was higher than that in PCI(13.3% in hospital,13.3% within 6 months of follow up) and fibrinolysis groups((22.2%) in hospital,11.1% within 6 months of follow up,P<0.05).Among the effective drugs,the rate of administration of clopidogrel or ticlopidine was the lowest,accounting for 24.4%.Glycosylated hemoglobin level was highin all patients and LDL-C>2.6 mmol/L accounted for 74.5% of all patients.Conclusions Reperfusion therapy for old female patients with diabetes and acute myocardial infarction is better than no reperfusion therapy.LDL-C and diabetes should be controlled effectively.