The Clinical Research Of Cardiac Protection On Perioperatively Intravenous Infusion Betaloc In Type 2 Diabetes Patients

Objective: To investigate the clinical effect of Type 2 diabetes mellitus (T2DM) undergoing noncardiac surgery with perioperatively intravenous infusion betaloc. Betaloc can reduce cardiovascular events in short term and raise life quality postoperatively with dose-effect relationship, and evaluation the safety and the interaction with anesthetics of betaloc. Methods Seventy ASA II～III NIDDM patients ,who were at a intermediate risk or more than two lower risk for postoperative cardiovascular events according to "ACC/AHA Guideline for Postoperative Cardiovascular Evaluation for Noncardiac surgery", were classified into control group (n=35) and Betaloc group (n=35) randomly. The heart rate and blood pressure of patients of Control group were not interfered by using betaloc. Before operative procedure, patients of betaloc group were intravenous betaloc 20μg/kg ,then pumped betaloc 0.1～1.0μg·kg^-1·min^-1 persistently . The average heart rate of patients of betaloc group was remained over 60 rates per minute and the blood pressure was keep over 90/50mmHg.Used the betaloc until the patients were sent to wards. The heart rates, blood pressure and ECG (especially the ST segment) of patients which include 24 hours before operation, operation and 24 hours postoperative were recorded by Holter,and the myoglobin was also monitored preoperatively. We also recorded consciousness recovery time of patients after stopping using anesthetics . The blood glucose of patients were detected before operation, postoperation and the next morning after operation. Observe the time of postoperation to discharge and the incidence of cardiovascular events. Results: 1,The heart rates of patients of control group was significant difference between postoperative and preoperative (P<0.05) . The incidence of arrhythmia in postoperative of betaloc group patients was lower than control group (P<0.05). 2,During the monitored period in postoperative, twelve patients in control group and five patients in betaloc group were observed myocardial ischemia. It was significant difference between the two groups(P<0.05). 3,The blood glucose of the patients of the two groups in postoperative were higher than preoperative, and there was no significant difference between the two groups (P > 0.05). The consciousness recovery time and the time of removing tracheal intubations after stopping using analgesics were no significant difference between the two groups (P > 0.05) . 4,The incidence of cardiovascular events of patients postoperative in two groups was significant difference (P<0.05) .The mortality of control group was lower than betaloc group(P<0.05). Conclusion: 1,T2DM can keep constant heart rates and reduce the incidence of arrhythmia postoperative and myocardial ischemic in the first day after operation by intravenous infusion betaloc during noncardiac surgery. 2,If the blood volumes of patients are sufficient, intravenous betaloc infusion is safe and effective. In the period of effective concentration it will not extend the persistence time of analgesic.3,We must learn the condition of patients thoroughly and control the blood glucose before aneasthesia. 4,It is necessary to strengthen monitor and treatment of postoperative arrhythmia of patients which have cardiovascular diseases.