The Effect Of Nicardipine On Perioperative Insulin Resistance In Patients With Essential Hypertension

Objective:To investigate the changes of insulin sensitivity andexplore the effect of nicardipine on insulin resistance in patients withessential hypertension(EH) during peri-operation.Methods: Fifty-seven ASAâ… orâ…¡patients aged 43-72 yrs,weighing45-71 kg undergoing lobectomy for lung cancer,which had no signs ofSecondary Hypertension, Diabetes Mellitus,liver function failure andrenal failure, were devided into three groups: group A (n=20, EssentialHypertension and Nicardipine), group B (n=19, Essential Hypertension),group C (n=18, without Essential Hypertension).IN group A nicardipin1μg·kg^-1·min^-1 was infused continuously after induction of anesthesiawhile in B and C groups normal saline was infused instead of nicardipin.MAP,HR, BIS,VAS and accumulated dose of Fentanly and propofol wererecored.Venous blood samples were obtained immediately beforeinduction of anesthesia (T₀,baseline),at the end of surgery(T₁),4h(T₂) and24h(T₃) after the end of operation for determination of the concentrationsof fasting plasma glucose(GOD-PAP) and insulin(radio-immunoassay).The value of ISI was determined with the formula introduced by Li Guangwei which calculate the value of ISI with the follow formula:ISI=ln[1/(INS×FPG)].Statistics treatment:The measurement data wasexpressed as "(?)±s", and using REPEATED MEASUREMENT ANOVAprogram and One-Way ANOVA program of SPSS 13.0 software toanalyze it.when the value of"p" is lower than 0.05,it has significance.Results: The age,body height,body weight,value of BMI,operationand anesthesia time,accumulated dose of Fentanly and propofol,value ofBIS and VAS had no significant difference in three groups (P＞0.05).MAP decreased in group A after induction of anesthesia,but MAP and HRalmost maintenancd steadily during operation; MAP in group B washigher and the change was obvious (P＜0.05, P＜0.05).MAP and HR ingroup C was steady.The concentrations of FPG and INS at T₂ and T₃increased significantly compared to baseline(T₀) in groups B and Cthan that in group A (P＜0.05,INS at T₃ P＜0.01).The concentrations ofFPG and INS at T₃ was significantly higher in group A than that atbaseline(T0) (P＜0.05).The value of ISI at T₃ was lower in group Acompared to baseline(T₀)(P＜0.05) and at T₂ and T₃ was significantlylower in groups B and C compared to baseline(T₀)(P＜0.05, at T₃ P＜0.01). The concentrations of FPG at T₂ and INS at T₃ and ISI at T₂and T₃ increased significantly in group A than that in group B (P＜0.05,INS at T₃ P＜0.01).The concentrations of FPG, INS and ISI at all times increased significantly in group C than that in group B (P＜0.05, INS at T₃P＜0.01).Conclusion:Patients with Essential Hypertension have insulinresistance before anesthesia induction,and developed significantincreasing of insulin resistance on the first pstoperative day, nicardipine canimprove the insulin resistance in Patients with Essential Hypertensionduring perioperation.