The Effect Of Pretreatment With Hydromorphone Preconditioning On Myocardial Protection In Patients With Coronary Heart Disease In Non-cardiac Surgery

Objective The purpose of this study was to investigate whether hydromorphone preconditioning had myocardial protection effect on non-cardiac surgery in patients with coronary heart disease,and to provide evidence for clinical application of hydromorphone in patients with coronary heart disease.Methods The 60 patients with coronary heart disease in non-cardiac surgery were selected and randomly divided into two groups,including control group and experiment group.The patients from the control group were injected with 2ml 0.9%saline for 15 minutes before anesthesia induction.The patients from the experiment group were given intramuscular injection of 2ml（2mg）hydromorphone for 15 minutes before anesthesia induction.All patients in both groups carried out general anesthesia with tracheal intubation.The induction of anesthesia was given midazolam0.02⁰.06mg/kg,sufentanil 0.1⁰.3ug/kg,cisatracurium 0.10⁰.15mg/kg,etomidate 0.1⁰.3mg/kg,and after 3min,all patients had a tracheal intubation carried out.The anesthesia during the surgery,sevoflurane 1%⁴%was maintained,remifentanil 0.05⁰.2ug/kg/min,propofol 100²00ug/kg/min was pumped,intermittent cisatracurium was used to maintain muscle relaxation.During the operation,BIS was monitored and maintained at 40⁶0,PETCO₂35⁴5 mmHg was maintained.At the end of the operation,inhaled propofol was discontinued half an hour before the end of the operation.Anesthetics and remifentanil was discontinued at the end of the operation,Oxygen flow 6⁸ L/min lung lavage,then PCIA was performed.The tracheal tube was removed to PACU at the end of the operation.The SBP,DBP,HR and ECG changes in two groups were recorded before intramuscular injection（T0）,before intubation（T1）,after intubation（T2）,1h after intramuscular injection（T3）and after extubation（T4）.The concentration of serum creatine kinase isoenzyme（CK-MB）,troponin I and myoglobin were detected before the operation,6h after intramuscular injection and 24h after intramuscular injection.Meanwhile,the concentration of adrenaline and norepinephrine were detected before the operation,6h after intramuscular injection and 24h after intramuscular injection.Results There was no significant difference in the general data of the two groups and the Comparison of intraoperative situation and the use of active drugs.There was also no significant difference in blood pressure for the two groups after intramuscular injection（T0）,before intubation（T1）,after intubation（T2）,1h after intramuscular injection（T3）,after extubation（T4）（P>0.05）.There was also no significant difference in heart rate for the two groups at T0（P>0.05）,however,there was a significant difference in heart rate for the two groups at T1,T2,T3,T4.Compared to the control group,heart rate in the experimental group was decreased at T1^T4（P<0.05）.There was also no significant difference in ECG changes for the two groups at T0,T1,T2,T3,（P>0.05）,however,there was a significant difference in ECG changes for the two groups at T4,compared with control group,ECG abnormal changes in the experimental group was decreased at T4（P<0.05）.There was also no significant difference in serum CK-MB and myoglobin concentration in the two groups before operation（P>0.05）,however,there was a significant difference in serum CK-MB and myoglobin concentration at 6h and 24h after intramuscular injection.Compared with the control group,the serum CK-MB and myoglobin level in the experimental group was decreased at6h and 24h after intramuscular injection（P<0.05）.The troponin I levels in the two groups were within the normal range before operation.At 6h and 24h after intramuscular injection,8 patients in control group had abnormal increasing.1patient showed abnormal increasing in the experimental group（P<0.05）.There was also no significant difference in plasma epinephrine and norepinephrine in the two groups before operation（P>0.05）,however,there was a significant difference in plasma epinephrine and norepinephrine at 6h and24h after intramuscular injection.Compared with the control group,the serum epinephrine and norepinephrine concentrations were decreased in the experimental group（P<0.05）.Conclusion Hydromorphone preconditioning may have myocardial protection effect on non-cardiac surgery in patients with coronary heart disease,and its mechanism may be that hydromorphone preconditioning inhibits anesthesia and stress response caused by surgery.