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目的:探讨在围手术期应用胰高血糖素样肽(GLP)-1与胰岛素对ST段抬高型心肌梗死(STEMI)合并应激性高血糖患者进行干预,比较两种干预方法对患者心肌灌注及预后的影响。方法:本研究为前瞻性、单中心、随机对照研究,连续入选首次发生STEMI并于12 h内接受急诊经皮冠状动脉介入治疗且入院即刻血糖≥11.1 mmol/L的非糖尿病患者114例,利用随机数字表分为观察组(GLP-1干预,59例)和对照组(胰岛素干预,55例)。对比两组术后心肌灌注、心肌损伤指标、心功能指标及心肌梗死面积(MIA)、心肌挽救指数(MSI),随访6个月,记录两组心血管不良事件(MACE)情况。结果:观察组围手术期肌酸激酶同工酶及心肌肌钙蛋白T的峰值较对照组降低(P<0.05);术后6个月,观察组心肌灌注、左心室射血分数均高于对照组(P<0.05),同时观察组较对照组患者MIA减少[(15±12)g vs(20±14)g,P<0.05],MSI增加12%(0.64±0.13 vs 0.56±0.12,P<0.001),但MACE发生差异无统计学意义(P=0.217)。结论:STEMI患者合并应激性高血糖,围手术期应用GLP-1可以在安全调节血糖的同时,逐步改善心肌灌注及心脏功能,减少MIA,但未发现其对围手术期的心肌灌注及6个月MACE发生产生影响。
Objective: To investigate the intervention of glucagon-like peptide (GLP) -1 and insulin in STEMI patients with stress hyperglycemia in perioperative period. To compare the effects of two interventions on myocardium Effect of perfusion and prognosis. METHODS: This prospective, single-center, randomized, controlled trial of 114 consecutive non-diabetic patients with STEMI who had undergone emergency percutaneous coronary intervention within 12 hours and had immediate glucose ≥11.1 mmol / L on admission was enrolled. Random number table is divided into observation group (GLP-1 intervention, 59 cases) and control group (insulin intervention, 55 cases). Myocardial perfusion, myocardial injury index, cardiac function index, myocardial infarction size (MIA) and myocardial salvage index (MSI) were compared between the two groups. The patients were followed up for 6 months. The adverse cardiovascular events (MACE) were recorded. Results: The peak values of creatine kinase and cardiac troponin T in the observation group were lower than those in the control group (P <0.05). At 6 months after operation, the myocardial perfusion and left ventricular ejection fraction in the observation group were significantly higher than those in the control group (15 ± 12) g vs (20 ± 14) g, P <0.05], and MSI increased by 12% (0.64 ± 0.13 vs 0.56 ± 0.12, P <0.05) in the observation group compared with the control group P <0.001), but there was no significant difference in MACE (P = 0.217). CONCLUSIONS: STEMI patients have stress hyperglycemia. Perioperative application of GLP-1 can improve myocardial perfusion and cardiac function, reduce MIA while safely regulating blood glucose, but no effect on perioperative myocardial perfusion and 6 MACE months have an impact.