小剂量硝酸甘油对腹腔镜胆囊切除术糖尿病患者围手术期心脏保护作用

Effects of small doses of nitroglycerin on perioperative myocardial protection for diabetic patients undergoing laparoscopic cholecystectomy

目的探讨围手术期小剂量硝酸甘油（nitroglycerin，NTG）对行腹腔镜胆囊切除术糖尿病患者的心肌保护作用。方法选择行择期腹腔镜胆囊切除术的糖尿病患者20例，用简单随机化方法分为NTG治疗组（A组，9例）和非NTG治疗组（B组，11例）。A组患者麻醉诱导时开始静脉泵注NTG（0．10—0．25μg·kg^-1·min^-1）至麻醉结束，B组给予生理盐水。比较分析两组患者术前30min（T1）、插管时（T2）、拔管时（T3）、术毕30min（T4）4个时点HR、MAP及术中血管活性药使用情况和围手术期心血管事件发生情况，并测定T1、T4、术后24h（T5）时点血清降钙素基因相关肽（calcitonin gene-related peptide，CGRP）浓度和T1、T5时点血清心肌肌钙蛋白I（cardiac troponin I，cTnI）浓度。结果与T1比较，A组B时点MAP下降显著（P〈0．05），B组T4时点MAP下降显著（P〈0．05），与T3时点比较，B组T4时点MAP下降显著（P〈0．05）；组间比较，B时点A组MAP[（92±9）mmHg（1mmHg=0．133kPa）]显著低于B组[（107±17）mmHg]，差异有统计学意义（P〈0．05）。两组HR无显著变化（P〉0．05）。与T1比较，B组血清CGRP浓度于T4及T5时点显著降低[T1、T4及T5时血清CGRP浓度分别为（16．4±3．5）、（14．1±3．6）、（13．2±2．4）ng／L，P〈0．05]；A组各时点血清CGRP浓度差异无统计学意义（P〉0．05）。与T1比较，B组血清cTnI浓度在T5时点显著升高（P〈0．05）；A组各时点间差异无统计学意义（P〉0．05）。结论小剂量NTG可稳定腹腔镜胆囊切除术糖尿病患者术中血清CGRP浓度和术后24h血清cTnI浓度，可能在围手术期发挥心肌保护作用。

Objective To investigate the effects of small doses of nitroglycerin （NTG） on perioperative myocardial protection for diabetic patients undergoing laparoscopic cholecystectomy. Methods A total of 20 diabetic patients scheduled for laparoscopic cholecystectomy were enrolled into the current study. They were randomly divided into two groups： an NTG treatment group （group A, n=9） and a non-treatment group （group B, n=11）. Patients in group A were intravenously infused with NTG at a rate of 0.10-0.25 μg·kg^-1·min^-1 from anesthesia induction to the end of anesthesia, while those in group B were given normal saline alone. Then, the two groups were compared for HR and MAP 30 rain before operation （T1）, during intubation （T2） and extubation （T3） and 30 min after operation（T4）. Meanwhile, vasoactive drug usage during operation and perioperative cardiovascular events were analyzed. Furthermore, the level of calcitonin gene-related peptide（CGRP） at T1, T4 and 24 h after operation（T5） as well as the amount of cardiac troponin I（cTnI） at T1 and T5 were measured. Results Remarkable decreases were found in MAP at T2 for group A and at T4 for group B, compared with those at T1（P〈0.05）. Furthermore, marked reduction was observed in MAP at T4 for group B, compared with those at T3（P〈0.05）. The MAP of group A [（92±9） mmHg （1 mmHg=0.133 kPa）] was significantly lower than that of group B [（107±17） mmHg] （P〈0.05）. However, no significant change was found in HR between the two groups（P〉0.05）. The levels of serum CGRP in group B at T4[（14.1±3.6） ng/L] and T5 [（13.2±2.4） ng/L] were remarkably lower than that at T1[（16.4±3.5） ng/L]（P〈0.05）. Meanwhile, no statistical difference was observed as to serum CGRP level at each time points in group A. Group B showed marked increases in the level of serum cTnI at T5 compared with T1 （P〈0.05）. No significant change was detected in cTnI at each time points for group A （P〉0.05）. Conclusions For diabetic patients undergoing laparoscopic cholecystectomy, small doses of NTG can stabilize their levels of serum CGRP during operation and cTnI 24 h after operation, which may result in perioperative myocardial protection.