高血糖对老年急性心肌梗死患者临床和预后的影响

Effect of Hyperglycemia on the Clinic and Prognosis of Acute Myocardial Infarction in the Aged Patients

目的:观察血糖升高对老年急性心肌梗死(AMI)患者临床和预后的影响。方法:选取老年AMI患者223例,根据入院第一次随机血糖分为3组,A组＜7．8mmol/L,B组7．8～11．0mmol/L,C组≥11．0mmol/L。A组为血糖正常组,B、C组为血糖升高组。结果:入院随机血糖高的患者,平均年龄较大[(68．8±7．5)岁比(71．6±7．3)岁、(74．3±7．1)岁,P＜0．05],C组与A组相比血甘油三酯[(1．57±0．83)mmol/L比(1．31±0．63)mmol/L,P＜0．05]、尿酸[(360．2±172．3)μmmol/L比(273±86．3)μmmol/L,P＜0．05]、肌酐[(125．2±90．5)μmmol/L比(85．7±23．6)μmmol/L,P＜0．05]浓度较高。与A组比较,B、C组复合壁心肌梗死多见(38．9%比59．7%、66．7%,P＜0．05)。C组与A组相比左室射血分数[(43．5±6．37)%比(58．5±8．36)%,P＜0．05]较低。与A组比较,B、C组患者溶栓再通率低(54．8%比40．6%、28．6%,P＜0．05),冠脉造影提示多支血管病变多见(51．6%比73．7%、69．2%,P＜0．05),C组比A组并发心力衰竭多见(35．4%比15．9%,P＜0．05),住院病死率(20．8%比4．5%,P＜0．05)增加。结论:老年AMI患者入院随机血糖升高,提示病情重、梗死面积大、并发症多、预后差及病死率高。

Objective： To investigate the effect of hyperglycemia on the clinic and prognosis of AMI in the aged patients, nethotis： 223 aged patients with AMI were derided into 3 groups according to the glucose level on admission： group A, 〈 7.8rnmol/L; group B, 7.8 - 11.0mmol/L; and group C, ≥ 11.0 mmol/L. Results： Compared with groupA, patients in the B and C were older, had higher triglycerides, uric acid, creatinine levels and the rate of compound myocardial infarction, low LVEF were aUhigher. The low- er rate of myocardial reperfusion, more 2 - vessel or 3 - vessel diseases, heart failure and mortality were all higher in hyperglycemia groups. Conclusion： Elevated glucose level on admission in the aged AMI patients indicates the more serious conditions, wider area of infarction, more complications, worse prognosis and higher mortahty.