应激性高血糖对急性心肌梗死患者心功能的影响

目的 探讨应激性高血糖对非糖尿病急性ST段抬高性心肌梗死(STEMI)患者心功能及住院期间并发症的影响.方法 对62例既往无糖尿病病史的STEMI患者分为应激性高血糖(A)组和非应激性高血糖(B)组.根据非糖尿病患者急性心肌梗死(AMI)后24 h内(空腹>8 h,静脉未应用葡萄糖注射液的患者)空腹血糖≥6.1 mmol/L作为应激性高血糖的判定标准.A组34例,B组28例.所有患者于入院第2周行心脏超声检查,测定左室舒张末期内径(LVDD)、左室收缩末期内径(LVDS)、射血分数(EF)及短轴缩短率(FS).比较两组心功能的差异,并且观察患者在住院期间内并发症的发生情况.结果 A组的EF和FS均明显低于B组,差异有统计学意义(P<0.01).多元回归分析发现:血糖与AMI患者的心功能独立相关,差异有统计学意义(P<0.05).AMI伴发应激性高血糖者住院期间并发症的发生较非应激性高血糖者有增多趋势,因病例数较少未行统计学处理.结论 AMI伴发应激性高血糖者的心功能明显低于非应激性高血糖者.血糖是AMI患者独立且与心功能有关的因素.

Effect of stress hyperglycemia on cardiac function in the patients with acute myocardial infarction

Objective To investigate the effect of stress hyperglycemia on cardiac function and complications of the patients with non-diabetic ST-elevation acute myocardial infarction (STEMI) in hospitalization. Methods According to the standard of stress hyperglycemia:in non-diabetic patients with AMI,fasting blood glucose(FBG) ≥6.1 mmol/L within 24 hours(fasting time>8 hours, and intravenous glucose injection was not allowed ), the 62 patients were divided into two groups:stress hyperglycemia group and non-stress hyperglycemia group. The stress hyperglycemia group had 34 cases;the non-stress hyperglycemia group had 28 cases. All the patients were examined by echocardiogram within the second week after their admission. Their LVDD, LVDS, EF and FS were examined and compared in two groups. In hospitalization period, the complications were also compared between two groups. Results EF and FS were obviously lower in stress hyperglycemia group than in non-stress hyperglycemia group.There were significantly statistical differences (P<0.01). Multiple Logistic regression analysis showed there was an independent relationship between the concentration of blood glucose and cardiac function of the patients with AMI. There was statistical difference (P<0.05). The incidence of complications was higher in patients with AMI and stress hyperglycemia than in non-stress hyperglycemia. Conclusion Cardiac function is lower in the patients with AMI and stress hyperglycemia than in non-stress hyperglycemia.The concentration of blood glucose is an independent factor and correlated with cardiac function in the patients with AMI.