门冬胰岛素注射液强化治疗对急诊经皮冠状动脉介入治疗后急性心肌梗死并应激性高血糖患者的影响

目的探讨门冬胰岛素注射液强化治疗对急诊经皮冠状动脉介入治疗(PCI)后急性心肌梗死(AMI)并应激性高血糖(SHG)患者的影响。方法选取2017年12月—2018年12月河北北方学院附属第二医院心内科收治的急诊PCI后AMI并SHG患者106例,根据胰岛素治疗方案分为对照组和观察组,每组53例。两组患者急诊PCI后均接受标准AMI药物治疗和内科综合治疗,对照组患者PCI后随机血糖>18.0 mmol/L时给予门冬胰岛素注射液皮下注射,观察组患者PCI后立即采用微量泵持续静脉泵注门冬胰岛素注射液,同时每晚睡前给予甘精胰岛素皮下注射;两组患者均连续治疗7 d。比较两组患者PCI后无复流发生情况及心肌灌注情况〔包括ST段抬高总和回落百分比(sumSTR)、TIMI心肌组织灌注分级(TMPG)、肌酸激酶同工酶(CK-MB)峰值〕,PCI前及PCI后7 d炎性因子〔包括白介素16(IL-16)和白介素18(IL-18)〕,PCI前及PCI后7、30 d左心功能指标〔包括左心室射血分数(LVEF)、左心室舒张末容积指数(LVEDVI)、左心室收缩末容积指数(LVESVI)〕,并记录两组患者治疗期间不良心血管事件发生情况。结果观察组患者PCI后无复流发生率低于对照组(P<0.05)。观察组患者PCI后sumSTR>50%者所占比例及CK-MB峰值高于对照组,TMPG优于对照组(P<0.05)。观察组患者PCI后7 d血清IL-16、IL-18水平低于对照组(P<0.05)。时间与方法在LVEF、LVESVI、LVEDVI上无交互作用(P>0.05),时间、方法在LVEF、LVESVI、LVEDVI上主效应显著(P<0.05)。观察组患者PCI后7、30 d LVEF高于对照组,LVESVI、LVEDVI小于对照组(P<0.05)。两组患者治疗期间不良心血管事件发生率比较,差异无统计学意义(P>0.05)。结论门冬胰岛素注射液强化治疗可有效减少急诊PCI后AMI并SHG患者无复流的发生,改善患者心肌灌注及左心功能,减轻炎性反应,且安全性较高。

Impact of Intensive Treatment of Insulin Aspart Injection on Acute Myocardial Infarction Patients Complicated with Stress Hyperglycemia after Emergency Percutaneous Coronary Intervention

Objective To investigate the impact of intensive treatment of insulin aspart injection on acute myocardial infarction(AMI)patients complicated with stress hyperglycemia(SHG)after emergency percutaneous coronary intervention(PCI).Methods From December 2017 to December 2018,a total of 106 AMI patients complicated with SHG after emergency PCI were selected in the Department of Cardiology,the Second Affiliated Hospital of Hebei North College,and they were divided into control group and observation group according to insulin treatment regimen,with 53 cases in each group.Patients in the two groups received standard drug therapy for AMI and internal medicine treatment after emergency PCI,moreover patients in control group received subcutaneous injection of insulin aspart injection when the random blood glucose was over 18.0 mmol/L,while patients observation group received intravenous pumping of insulin aspart injection by microinfusion pump immediately after emergency PCI and subcutaneous injection of insulin glargine before sleeping per night;both groups continuously treated for 7 days.Incidence of no-reflow and myocardial perfusion indicators(including sumSTR,TMPG,peak value of CK-MB)after emergency PCI,as well as inflammation cytokines(including IL-16 and IL-18)before PCI and 7 days after PCI,index of left ventricular function(including LVEF,LVEDVI,LVESVI)before PCI,7 and 30 days after PCI were compared between the two groups,and incidence of adverse cardiovascular events was observed during treatment.Results Incidence of no-reflow in observation group was statistically significantly lower than that in control group after PCI(P<0.05).Proportion of patients with sumSTR>50%and peak value of CK-MB in observation group were statistically significantly higher than those in control group after PCI,moreover TMPG in observation group was statistically significantly better than that in control group(P<0.05).Serum levels of IL-16 and IL-18 in observation group were statistically significantly lower than those in control group 7 days after PCI(P<0.05).There was no statistically significant interaction in LVEF,LVESVI or LVEDVI between time and method(P>0.05);main effects of time and method were statistically significant in LVEF,LVESVI and LVEDVI(P<0.05).LVEF in observation group was statistically significantly higher than that in control group 7 and 30 days after PCI,respectively,while LVESVI and LVEDVI in observation group were statistically significantly lower than those in control group(P<0.05).There was no statistically significant difference in incidence of adverse cardiovascular events between the two groups during treatment(P>0.05).Conclusion In AMI patients complicated with SHG after emergency PCI,intensive treatment of insulin aspart injection can effectively reduce the risk of no-reflow and inflammatory reaction,improve the myocardial perfusion and left ventricular function,with relatively high safety.