老年AMI应激激素和血糖变化及对预后的影响

目的观察急性心肌梗死（AMI）老年患者的应激激素和血糖水平的变化情况，探讨其对疾病预后的影响。方法收集老年急性心肌梗死患者90例，以入院时患者测量的血糖水平〈7．8mmol／L的51例患者作为非应激性高血糖组；以血糖≥7．8mmol／L的39例患者作为应激性高血糖组。结果与非应激性高血糖组比较，应激性高血糖组患者的随机血糖、皮质醇、生长激素、胰高血糖素、ACTH及发生心力衰竭、再发心肌梗死、梗死后心绞痛、严重心律失常及因心血管死亡的构成比均较高，胰岛素水平及左心室摄血分数明显较低，以上观察指标差异均有统计学意义（P〈0．05）。结论老年急性心肌梗死患者在入院时的血糖和应激激素水平的异常变化严重影响患者的预后。

Change of Stress Hormone and Blood Glucose Levels in Elderly with AcuteMyocardial Infarction(AMI)and the Impact on Prognosis

Objective To observe the change of stress hormone and blood glucose levels in elderly patients with acute myocardial infarction and explore their impact on prognosis. Methods All 90 elderly patients with acute myocardial infarction were selected. Admission of patients to measure blood glucose levels 〈 7.8mmol/L in 51 patients as a non-stress-induced hyperglycemia; To blood glucose ≥ 7.8mmol/L in 39 patients as a stress-induced hyperglycemia. Results Compared with non-stress-induced hyperglycemia group, stress-induced hyperglycemia in patients with random blood glucose, cortisol, growth hormone, glucagon, ACTH and heart failure, recurrent myocardial infarction, postinfarction angina, serious arrhythmias and death due to cardiovascular proportions were higher; insulin levels and left ventricular ejection fraction were lower, all of observed indicators had significant differences （ P 〈 0.05 ）. Conclusion Elderly patients with acute myocardial infarction in the admission blood glucose and elevated stress hormone abnormalities seriously affect the prognosis of patients.