缺血预适应对急性心肌梗死合并糖尿病患者预后的影响

目的　探讨心肌缺血预适应对急性心肌梗死合并糖尿病患者临床状况及近期预后的影响。方法　 6 7例确诊为急性心肌梗死同时合并有糖尿病的患者 ,根据心肌梗死发病前 1周内有无心绞痛发作分为缺血预适应组 (2 8例 )和对照组 (39例 ) ,两组基础临床情况类似。观察心肌梗死范围、心肌酶学改变、左室射血分数及住院期间泵衰竭、心源性休克、严重心律失常等心脏事件的发生率和病死率。结果　缺血预适应组患者临床状况及近期预后较好 ,与对照组相比 ,梗死面积小 ,≥ 2个梗死面的检出率低 (32 .1%与 5 6 .4 % ,P <0 .0 5 ) ,血浆CPK、CK MB、cTnT峰值均显著降低 (P <0 .0 1或P <0 .0 5 ) ,且住院期间的泵衰竭发生率(17.9%与 4 1.0 % ,P <0 .0 5 )、心源性休克 (10 .7%与 33.3% ,P <0 .0 5 )、严重心律失常 (14 .3%与 4 6 .2 % ,P<0 .0 1)及住院病死率 (3.6 %与 2 0 .5 % ,P <0 .0 5 )均降低。结论　缺血预适应对急性心肌梗死合并糖尿病的患者有保护作用 ,可以减少心肌梗死面积 ,降低临床并发症的发生率 ,但不能改善左室射血分数与促进心功能的恢复

Effect of ischemic preconditioning on prognosis of acute myocardial infarction in patients with diabetes mellitus

Objective To explore the effects of ischemic preconditioning(IP) on the clinical feature and short term prognosis of acute myocardial infarction(AMI) in patients with diabetes mellitus.Methods 67 cases of AMI with diabetes were divided into two groups: IP group(n=28) suffering from angina pectoris within 1 week before AMI and the control group(n=39).The basic clinical characteristics of the two groups were similar.The infarct size,peak level of CPK,CK MB,cTnT,ejection fraction and the clinical complications were observed; the incidence of heart failure,cardiogenic shock,serious arrhythmia and in hospital mortality were compared.Results The condition and the short term prognosis in IP group were better than the control group.The infarct size,the peak level of CPK,CK MB,cTnT,the incidence of heart failure,cardiogenic shock,serious arrhythmia and in hospital mortality in IP group were all significantly lower than those in the control group(P<0.01 or P<0.05).Conclusion The ischemic preconditioning may protect diabetic patients with AMI,reduce the size of myocardial infarction and the incidence of clinical complications but can not improve ejection fraction and enhance recovery of ventricular function .