2型糖尿病并发无痛性急性心肌梗死40例

Study of silent acute myocardial infarction in 40 patients with type 2 diabetes mellitus

目的 探讨2型糖尿病（T2DM）并发无痛性急性心肌梗死（AMI）的临床特点和诊治对策。方法将40例患者的临床特点，按有无心源性休克分为无休克纽（n=32）和休克纽（n=8），无休克纽给予单硝酸异山梨酯类注射液（鲁南欣康注射液）静脉滴注，休克组患者休克纠正后给予鲁南欣康注射液静脉滴注，观察其疗效。结果T2DM并发无痛性急性心肌梗死的主要临床特征为胸闷、心悸、呼吸困难、倦怠乏力、恶心、呕吐、心律失常、心力衰竭和心源性休克；9例患者低血糖后发生AMI；休克组患者急性期病死率（62．5％）显著高于无休克组（13．6％）（P〈0．01）。结论低血糖是重要的可预防的诱发因素之一。积极控制血糖，预防低血糖，及时确诊无痛性AMI，并及早给予单硝酸异山梨酯类药物和综合治疗，可明显改善患者的预后。

Objective To study the clinical features of silent acute myocardial infarction （AMI） in patients with type 2 diabetes mellitus and steps for treatments. Methods We selected 40 patients with AMI, which were silent （no pain）. They were divided into no shock group （n = 32） and shock group （n = 8 ）, 37 cases were treated with isosorbide 5 - mononitrate. And observe their efficacy. Results Their main clinical features included chest depressed, palpitation, dyspnea, fatigure, nausea, vomiting, cardiac arrhythmia, heart failure and cardiac shock. Nine cases of AMI happened after hypoglycemia. Mortality in early stage of cardiac shock （62. 5% ） were significantly higher than that of no cardiac shock （ 13.6% ）, P 〈 0. 01. Conclusions One of important factors causing silent AMI is hypoglycemia and it can be prevented. Effective treatments included good control of glucose, prevention of hypoglycemia, timely diagnoses of silent AMI, using of isosorbide 5 - mononitrate and general therapeutic steps in early stage.