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；经皮冠状动脉介入术；门冬胰岛素注射液；无复流现象；心肌微灌注

Keywords：

Acute myocardial infarction；Stress hyperglycemia；Percutaneous coronary intervention；Insulin aspartinjection；No reflow；Myocardial microperfusion

CLC：

R 542.22

DOI：

DOI：10.3969/j.issn.1008-5971.2020.05.001

Funds：

张家口市重点研发计划项目（1921022D）

摘要：

背景　急性心肌梗死（AMI）伴应激性高血糖（SHG）患者经皮冠状动脉介入术（PCI）后心肌微灌注及复流现象可能会受到一定影响，而进行 SHG 强化治疗对改善患者预后具有重要意义。目的　探讨门冬胰岛素注射液强化治疗对 AMI 伴 SHG 患者 PCI 后心肌微灌注及无复流现象的影响。方法　选取河北北方学院附属第二医院 2016年 4 月—2018 年 6 月收治的 AMI 伴 SHG 患者 106 例，按照随机数字表法分为对照组（n=53）和观察组（n=53）。两组患者均采用 PCI 治疗，术后对照组患者采用常规降糖药物治疗，观察组患者在对照组基础上给予门冬胰岛素注射液强化治疗。比较两组患者术前及术后 1 周血清白介素 18（IL-18）、白介素 16（IL-16）水平，术后 1 周心肌微灌注指标（包括心肌显像峰值强度、曲线上升至平台期斜率、峰浓度、达峰时间及心肌微灌注血流量），术前、术后 1 周及术后 1 个月心功能指标〔包括左心室舒张末容量指数（LVEDVI）、左心室收缩末容量指数（LVSVI）、左心室射血分数（LVEF）〕，术后 1 年无复流现象、主要不良心血管事件（MACE）发生情况。结果　两组患者术前血清 IL-18、IL-16 水平比较，差异无统计学意义（P>0.05）；观察组患者术后 1 周血清 IL-18、IL-16 水平低于对照组（P<0.05）。观察组患者术后 1 周心肌显像峰值强度、曲线上升至平台期斜率、峰浓度及心肌灌注血流量高于对照组，心肌显像达峰时间短于对照组（P<0.05）。两组患者术前 LVEDVI、LVSVI、LVEF 及术后 1 周、1 个月 LVEF 比较，差异无统计学意义（P>0.05）；观察组患者术后 1 周、1 个月 LVEDVI、LVSVI 低于对照组（P<0.05）。观察组患者术后 1 年无复流现象发生率低于对照组（P<0.05）。两组患者术后 1 年 MACE 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轻 AMI 伴 SHG 患者 PCI 后炎性反应，改善患者心肌微灌注及心功能，减少无复流现象发生，且安全性高。

Abstract：

【Abstract】　Background　Acute myocardial infarction （AMI） patients complicated with stress hyperglycemia（SHG）after percutaneous coronary intervention （PCI） can affect myocardial microperfusion and no reflow，and intensivetreatment of SHG for this situation is of great significance to the prognosis of patients. Objective　To discuss impact of insulinaspart injection intensive treatment on myocardial microperfusion and no reflow after PCI in AMI patients complicated with SHG.Methods　A total of 106 AMI patients complicated with SHG admitted to the Second Affilated Hospital of Hebei North Universityfrom April 2016 to June 2018，and they were divided into control group（n=53） and observation group （n=53） according torandom number table method.Both groups received PCI，patients in control group were treated with conventional hypoglycemicscheme，and patients in observation group were given insulin aspart injection intensive treatment based on control group.Serumlevels of IL-18 and IL-16 before operation and 1 week after operation，myocardial microperfusion indexes（including peakintensity of myocardial imaging，slope of curve rising to plateau，peak concentration，peak time and myocardial microperfusionblood flow） 1 week after operation，cardiac function indexes（including LVEDVI，LVSVI and LVEF） before operationand 1 week，1 month after operation，incidence of no reflow and MACE 1 year after operation were compared between the twogroups. Results　There was no significant difference in serum levels of IL-18 or IL-16 between the two groups before operation（P>0.05）；serum levels of IL-18 and IL-16 in observation group were lower than those in control group 1 week after operation（P<0.05）. Peak intensity of myocardial imaging，slope of curve rising to plateau in observation group were larger than thosein control group，peak concentration and myocardial microperfusion blood flow in observation group were higher than those incontrol group，peak time of myocardial imaging in observation group was shorter than that in control group（P<0.05）. Therewere no significant difference in LVEDVI，LVSVI，LVEF before operation or LVEF 1 week，1 month after operation betweenthe two groups（P>0.05）；LVEDVI，LVSVI in observation group were lower than those in control group 1 week，1 monthafter operation（P<0.05）. Incidence of no reflow in observation group was lower than that in control group 1 year after operation（P<0.05）. There was no significant difference in incidence of MACE between the two groups 1 year after operation（P>0.05）.Conclusion　Insulin aspart injection intensive treatment can effectively reduce inflammatory response of AMI patientscomplicated with SHG after PCI，improve myocardial microperfusion and cardiac function of patients，and reduce incidence ofno reflow，and with retively high safety.

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