合并糖尿病的老年急性心肌梗死病人的临床分析

Clinical analysis of acute myocardial infarction with diabetic patients in elderly

目的 对合并Ⅱ型糖尿病（ＮＩＤＤＭ） 的老年急性心肌梗死（ＡＭＩ） 病人的临床特点作初步分析。方法 对４０ 例合并ＮＩＤＤＭ 的老年ＡＭＩ病人（ＮＩＤＤＭ 组），和一般情况及梗死部位配对的无糖尿病的ＡＭＩ病人（非ＮＩＤＤＭ 组）８０ 例进行临床上的对比研究。结果 无痛性心肌梗死、ＡＭＩ后严重并发症（心源性休克、心力衰竭、严重心律失常） 的发生率及住院病死率有显著性显异，ＮＩＤＤＭ 组均高于非ＮＩＤＤＭ 组（Ｐ＜０－０５） 。ＡＭＩ后院内感染率，ＮＩＤＤＭ 组更是显著高于非ＮＩＤＤＭ 组（４０％ 比１８－８％ ，Ｐ＜ ０－０１） 。结论 合并Ⅱ型糖尿病的老年ＡＭＩ病人的无痛性心肌梗死和院内感染发生率高，严重心脏并发症多，住院病死率高，预后差。

Objective To investigate the clinical characteristics of acute myocardial infarction (AMI) with non-insulin dependent diabetes mellitus (NIDDM) patients in elderly.Methods 40 AMI with NIDDM patients in elderly (NIDDM group) and AMI with nondiabetic patients (N-NIDDM group) matched for age, sex, myocardial infarct site were analyzed to compare the clinical states.Results There were no differences between the two groups in medical history, peak date of creatin phosphokinase (CPK) and CPK isoenzymes. In NIDDM group, the incidence rate for painless myocardial infarction, congestive heart failure, cardiogenic shock, serious arrhymia and in hospital mortality were 25%, 35%, 20%,30%,20%, respectively. And in the N-NIDDM group were 5%, 15%, 7 5%, 12.5%, 7.5%, respectively. There were significant differences between the two groups ( P<0.05 ). The incidence of nosocomial infection of NIDDM group and N-NIDDM group was 40% vs 18 8%( P<0.01 ).Conclusions AMI with NIDDM patients in elderly had higher incidence of painless myocardial infarction complication, nosocomia infection, in-hospital mortality after AMI. It is important to pay attention to control higher glucose and hiperlipidemia, discover painless myocardial infarction early, preventing infection. It will be significantly useful in clinical pratice.