糖尿病并发急性心肌梗死溶栓后冠状动脉开通者的近期预后

The early prognosis of diabetic patients complicated with acute myocardial infarction after reperfusion of coronary artery by thrombolytic therapy

目的 :研究糖尿病并发急性心肌梗死 (AMI)溶栓治疗冠状动脉完全开通后的近期预后。方法 :对 2 1例糖尿病并发 AMI溶栓后 ,急诊冠状动脉造影显示梗死冠状动脉开通者的冠状动脉造影结果进行分析 ,并于梗死后 3～ 4周内行核素心室造影和 2 4h动态心电图检查 ,观察心功能、心肌缺血和心律失常的情况 ,且随访梗死后 3～ 5周内心绞痛等并发症的发生率 ,并与 37例非糖尿病 AMI溶栓后冠状动脉开通者进行比较。结果 :与非糖尿病组相比 ,糖尿病组冠状动脉的残余狭窄较重 ,冠状动脉病变积分较高 ;梗死后近期左室功能较差 ,心肌缺血的发生率较高。结论 :糖尿病并发 AMI溶栓后冠状动脉开通者冠状动脉病变仍然较重 。

Objective:To compare the difference of the early prognosis between diabetic and non diabetic patients complicated with acute myocardial infarction (AMI) after complete reperfusion of coronary artery by thrombolytic therapy.Method:The angiographic manifestation of 21 cases of diabetic and 37 cases of non diabetic patients complicated with AMI who received thrombolysis and the infarct related coronary artery were re opened indicated by emergency coronary angiography after thrombolysis were analysed.24 hours ambulatery electrocardiogram and radionuclide ventriculography were tested 3～4 weeks after infarction,and all patients were received 4～5 weeks follow up.Result:In diabetic group,the residual stenosis of infarct related artery and the coronary artery disease score were ( 93.10 ± 2.62 )% and ( 10.14 ± 1.98 ),significantly higher than control group 〔( 76.05 ± 9.42 )% and ( 5.78 ± 3.16 )% respectively〕 (P< 0.01 ).Three vessel diseases were most common in diabetic patients,but in non diabetic patients,single vessel diseases were more than two and three vessel diseases.After infarction,in diabetic group,LVEF were ( 0.57 ± 0.28 )%,lower than non diabetic group ( 0.71 ± 0.12 )% (P< 0.05 );but the rate of myocardial ischemia attack were 52.38 %,higher than non diabetic group ( 9.52 %) (P< 0.05 ).Conclusion:In diabetic patient with AMI,although the infarct related coronary artery is re opened by thrombolysis,the disease of coronary artery is still severe and the early prognosis is worse compare with non diabetic patient.