| Objective:The aim of the study was to investigate the effect of nitroglycerin(NTG)on cardio-protection in middle-aged and aged patients,with diabetes mellitus,hypertension and myocardial ischemia,undergoing laparoscopic cholecystectomy,evaluated by changes of serum Calcitonin Gene-Related Peptide(CGRP)and cardiac troponin I(cTn?),perioperatively.Methods:Seventy middle-aged and aged patients undergoing elective laparoscopic cholecystectomy(LC)were enrolled,9 of which was in normal control group(as group N),20 in diabetes group(as group A),22 in hypertension group(as group B)and 19 in myocardial ischemia group(as group C).According to whether or not treated with nitroglycerin,the last three groups were randomly divided into the treatment group(as group T)and the non-treatment group(as group n T),then they were each recorded as group A-T(n=9),B-T(n=11),C-T(n=10)and group A-n T(n=11),B-n T(n=11),C-n T(n=9).The patients in treatment group received intravenous infusion of nitroglycerin at rate of 0.1~0.25 ?g/kg/min throughout the anesthesia,while the patients in non-treatment group were given normal saline instead.And the blood pressures,heart rate,electrocardiogram and pulse oxygen saturation were routinely monitored.Comparisons were made for the heart rate(HR)and the mean arterial pressure(MAP)at30min before start of operation,immediately at intubation,extubating and 30 min after operation(described as T1,T2,T3 and T4,respectively).Blood samples were collected for evaluation of CGRP at T1,T4 and 24 hours after operation(T5)and for cTn? at T1 and T5 only.Results:1.Compared to that at T1,the serum CGRP levels in group N at T4 and in group A-n T at T4 and T5 were significantly lower(p < 0.05),but group A-T was stable;that compared with group N,CGRP in group A-n T at T1 was significantly increased(p <0.05),and there were no significant changes between group A-T and group A-n T at each time point.Then cTnI in group A-n T at T5 was significantly higher than that at T1(p <0.05),however,that in group N and group A-T was not;and that compared with group N,cTn? in group A-n T at T5 was significantly increased(p < 0.05),but there was no significant difference between A-T group and A-n T group at each time point.2.Compared to that at T1,CGRP in group N and group B-n T at T4 and in group B-T at T4 and T5 were significantly lower(p < 0.05);and there was no significant difference during three groups.Then the changes of cTn? in three groups were no significance between T1 and T5;compared to group N,cTn? in group B-n T at T1 was greatly decreased,and there was no clear difference between group B-T and group B-n T.3.The serum CGRP levels in group N at T4 and in group C-n T at T4 and T5 were significantly lower than that at T1(p < 0.05),but group C-T was stable;and there were no significant changes between group N and group C-n T at each time point,however that compared with group C-n T,CGRP in group C-T at T4 was significantly increased(p <0.05).Then the changes of cTn? in three groups were no significance between T1 and T5;compared to group N,cTn? in group C-n T at T1 was greatly decreased,and there was no clear difference between group C-T and group C-n T.4.None of the patients in this study had a serious cardiovascular event,and the use of a 0.1~0.25?g/kg/min dose of NTG did not induce clinically significant hemodynamic fluctuations.Conclusion:NTG can stabilize the diabetes and myocardial ischemia in patients with perioperative serum CGRP and the diabetes with cTn?,which could reduce the risk of surgery,anesthesia and stimulation on myocardial injury in patients with diabetes and myocardial ischemia;protective effect on hypertension patients needs further study. |
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