Эффективность агрессивной медикаментозной терапии ранней постинфарктной стенокардии у больных сахарным диабетом

Аннотация

Subjects of research: The study involved 90 patients admitted to the cardiac resuscitation department with a diagnosis of acute myocardial infarction (development of pain within 72 hours), and the development of EPA for the first 3 days of ML Mean age of patients was 61,9 ± 11,3 (39-81 years), including 57 men (63.3%). Purpose of work: To study the efficacy and safety of various schemes of aggressive drug therapy of early postinfarction angina in patients with diabetes mellitus. Methods of research: Clinical examination, assessment of pain (by Voennov O.V. scale), echocardiography (EchoCG), Holter monitoring of ECG, the analysis of lipids, creatine kinase MB, CRP levels in blood. The results obtained and their novelty: For the first time in diabetic patients was performed a comparative analysis of characteristics of pain and the EPA, also studied clinical course of painless myocardial ischemia with HMECG. Found that in diabetic patients with EPA a total duration of myocardial ischemia by HMECG was quite high, main part was painless myocardial ischemia (87%). In diabetic patients with EPA revealed conservation of elevated levels of important prognostic markers of myocardial infarction (CRP and CPK MB) on the steadystate period, and ischemic complications of acute myocardial infarction in the stationary phase (recurrent MI, AHF) and post-infarction period within 1 year (previous MI, deaths ) in this group were higher. It has been shown that the use of high doses of simvastatin and clopidogrcl as part of standard therapy in diabetic patients with EPA in the stationary period was relatively safe, has reduced the number of ischemic events (recurrent MI, and AHF by 15%) to the level of patients who did not have diabetes. According to results of HMECG found reduction of total duration of myocardial ischemia (including painless). It was noted that under influence of high doses of simvastatin increased the rate of reduction of inflammatory markers - CRP (81.6%) to the level of non-diabctic patients. Practical value: Results of the study extended knowledge about the features of the clinical course of EPA, associated diseases and their complications, as well as the nature of pain in a separate group of patients (DM with AMI), which has great practical importance in the diagnosis of EPA. Based on these results was developed by a secure method of aggressive therapy for patients who arc at high risk. As a result, this method reduces the number of ischemic events (recurrent MI, acute and chronic heart failure) and duration of treatment without the use of invasive methods, especially in the periphery. Degree of embed and economic effictivity: results of a study implemented in the form of methodological recommendations for cardiac resuscitation department of RSCC and 1st clinic of Tashkent Medical Academy, Jizzakh regional cardiologic dispensary. Field of application: departments of resuscitation and intensive therapy with cardiological and therapeutic profile.