作者：孟爱亮，武莉芳，孙伯玉，王辉，王佳敏

单位：

075100 河北省张家口市，河北北方学院附属第二医院急诊科；通信作者：孟爱亮，E-mail：malzjk11@163.com

关键词：

心肌梗死；应激性高血糖；经皮冠状动脉介入治疗；门冬胰岛素注射液；炎性因子；心功能

Keywords：

Myocardial infarction；Stress hyperglycemia；Percutaneous coronary intervention；Insulin aspartinjection；Inflammation cytokines；Cardiac function

CLC：

R 542.22

DOI：

DOI：10.3969/j.issn.1008-5971.2020.04.020

Funds：

张家口市重点研发计划项目（1921022D）

摘要：

目的　探讨门冬胰岛素注射液强化治疗对急诊经皮冠状动脉介入治疗（PCI）后急性心肌梗死（AMI）并应激性高血糖（SHG）患者的影响。方法　选取 2017 年 12 月—2018 年 12 月河北北方学院附属第二医院心内科收治的急诊 PCI 后 AMI 并 SHG 患者 106 例，根据胰岛素治疗方案分为对照组和观察组，每组 53 例。两组患者急诊 PCI后均接受标准 AMI 药物治疗和内科综合治疗，对照组患者 PCI 后随机血糖 >18.0 mmol/L 时给予门冬胰岛素注射液皮下注射，观察组患者 PCI 后立即采用微量泵持续静脉泵注门冬胰岛素注射液，同时每晚睡前给予甘精胰岛素皮下注射；两组患者均连续治疗 7 d。比较两组患者 PCI 后无复流发生情况及心肌灌注情况〔包括 ST 段抬高总和回落百分比（sumSTR）、TIMI 心肌组织灌注分级（TMPG）、肌酸激酶同工酶（CK-MB）峰值〕，PCI 前及 PCI 后 7 d 炎性因子〔包括白介素16（IL-16）和白介素18（IL-18）〕，PCI前及PCI后7、30 d左心功能指标〔包括左心室射血分数（LVEF）、左心室舒张末容积指数（LVEDVI）、左心室收缩末容积指数（LVESVI）〕，并记录两组患者治疗期间不良心血管事件发生情况。结果　观察组患者 PCI 后无复流发生率低于对照组（P<0.05）。观察组患者 PCI 后 sumSTR>50% 者所占比例及 CK-MB 峰值高于对照组，TMPG 优于对照组（P<0.05）。观察组患者 PCI 后 7 d 血清 IL-16、IL-18 水平低于对照组（P<0.05）。时间与方法在 LVEF、LVESVI、LVEDVI 上无交互作用（P>0.05），时间、方法在 LVEF、LVESVI、LVEDVI 上主效应显著（P<0.05）。观察组患者 PCI 后 7、30 d LVEF 高于对照组，LVESVI、LVEDVI 小于对照组（P<0.05）。两组患者治疗期间不良心血管事件发生率比较，差异无统计学意义（P>0.05）。结论　门冬胰岛素注射液强化治疗可有效减少急诊 PCI 后 AMI 并 SHG 患者无复流的发生，改善患者心肌灌注及左心功能，减轻炎性反应，且安全性较高。

Abstract：

Objective　To investigate the impact of intensive treatment of insulin aspart injection on acute myocardialinfarction （AMI）patients complicated with stress hyperglycemia （SHG）after emergency percutaneous coronary intervention （PCI）.Methods　From December 2017 to December 2018，a total of 106 AMI patients complicated with SHG after emergency PCIwere selected in the Department of Cardiology，the Second Affiliated Hospital of Hebei North College，and they were dividedinto control group and observation group according to insulin treatment regimen，with 53 cases in each group. Patients in thetwo groups received standard drug therapy for AMI and internal medicine treatment after emergency PCI，moreover patients incontrol group received subcutaneous injection of insulin aspart injection when the random blood glucose was over 18.0 mmol/L，while patients observation group received intravenous pumping of insulin aspart injection by microinfusion pump immediatelyafter emergency PCI and subcutaneous injection of insulin glargine before sleeping per night；both groups continuously treated for7 days. Incidence of no-reflow and myocardial perfusion indicators（including sumSTR，TMPG，peak value of CK-MB）afteremergency PCI，as well as inflammation cytokines（including IL-16 and IL-18）before PCI and 7 days after PCI，index ofleft ventricular function（including LVEF，LVEDVI，LVESVI）before PCI，7 and 30 days after PCI were compared betweenthe two groups，and incidence of adverse cardiovascular events was observed during treatment. Results　Incidence of no-reflowin observation group was statistically significantly lower than that in control group after PCI（P<0.05）.Proportion of patientswith sumSTR>50% and peak value of CK-MB in observation group were statistically significantly higher than those in controlgroup after PCI，moreover TMPG in observation group was statistically significantly better than that in control group（P<0.05）.Serum levels of IL-16 and IL-18 in observation group were statistically significantly lower than those in control group 7 daysafter PCI（P<0.05）.There was no statistically significant interaction in LVEF，LVESVI or LVEDVI between time and method（P>0.05）；main effects of time and method were statistically significant in LVEF，LVESVI and LVEDVI（P<0.05）.LVEFin observation group was statistically significantly higher than that in control group 7 and 30 days after PCI，respectively，whileLVESVI and LVEDVI in observation group were statistically significantly lower than those in control group（P<0.05）.Therewas no statistically significant difference in incidence of adverse cardiovascular events between the two groups during treatment（P>0.05）. Conclusion　In AMI patients complicated with SHG after emergency PCI，intensive treatment of insulin aspartinjection can effectively reduce the risk of no-reflow and inflammatory reaction，improve the myocardial perfusion and leftventricular function，with relatively high safety.

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