糖尿病患者静脉溶栓治疗急性心肌梗塞临床对比研究

A contrast study on clinical effect of intravenous thrombolysis therapy on acute myocardial infarction patients with diabetes and without diabetes

目的 探讨糖尿病患者静脉溶栓治疗急性心肌梗塞临床近期疗效。方法 冠心病监护病房 (CCU)收治的182例急性心肌梗塞患者 ,分成糖尿病 (DM- AMI)组、非糖尿病 (NDM- AMI)组。其中 DM- AMI组 6 6例、NDM- AMI组116例。两组同时给予国产尿激酶静脉溶栓治疗。结果 1DM- AMI组住院病死率为 15 .15 % ,明显高于 NDM- AMI组的 6 .0 3% (χ2 =4.17,P <0 .0 5 ) ;DM- AMI组静脉尿激酶溶栓治疗梗塞相关血管 (IRA)的再通率为 45 .45 % ,明显低于NDM- AMI组的 6 2 .93% (χ2 =5 .2 3,P<0 .0 5 ) ,2 DM- AMI组静脉血糖 (BS)、肌酐 (CR)、尿素氮 (BUN)、胆固醇 (TC)和甘油三酯 (TG)浓度均显著高于 NDM- AMI组 (P <0 .0 1,P <0 .0 5 ) ;3DM- AMI组合并症明显高于 NDM- AMI组 ,尤以心力衰竭最显著 (36 .36 % vs12 .97% ,χ2 =13.72 ,P <0 .0 0 1) ,其次为心源性休克 (16 .6 7% vs6 .0 3% ,χ2 =5 .33,P<0 .0 5 )。结论 静脉溶栓治疗急性心肌梗塞对非糖尿病患者合并急性心肌梗塞近期疗效显著 ,但对于糖尿病患者合并的急性心肌梗塞近期疗效不明显。

Objective The aim of this study was to observe the clinical effect of intravenous thrombolysis therapy on diabetic patients with acute myocardial infarction. Methods In the coronary care unit (CCU) at our hospital, 182 of the patients with acute myocardial infarction were divided into two groups with (DM AMI) and without diabetes (NDM AMI). All patients were treated with intravenous thrombolysis therapy. Results ①Hospital mortality in DM AMI groups was 15 15%, and 6 03% in NDM AMI(χ 2=4 17,P<0 05).The reperfusion rate of infarct related artery (IRA) was 45 45% in DM AMI groups, and 62 93% in NDM AMI groups (χ 2=5 23,P<0 05).②BS、CR、BUN、TC and TG in DM AMI groups were significantly higher than in NDM AMI groups (P<0 001、P<0 05).③Complications of AMI were significantly higher in DM AMI groups than in NDM AMI, with left ventricular failure significantly higher (36 36% vs 12 97%,χ 2=13 72,P<0 001) and cardial shock significantly higher (16 67% vs 6 03%,χ 2=5 33,P<0 05).Conclusion This study showed that intravenous thrombolysis therapy exerted a beneficial effect on the early term prognosis of AMI patients without diabetes. But for the patients with diabetes intravenous thrombolysis therapy did not show a beneficial effect.