喷他佐辛对糖尿病下肢手术患者心肌肌钙蛋白I的影响

Effects of pentazocine on postoperative cardiac troponin I in diabetic patients undergoing lower limb surgery

目的观察合并糖尿病行择期下肢手术患者术后心肌肌钙蛋白I(cardiac troponin I,cTnI)的变化以及喷他佐辛对其影响。方法蛛网膜下腔麻醉下行择期下肢骨科手术患者93例,分为非糖尿病组(NDM组,31例)、糖尿病喷他佐辛干预组(DM-P组,31例)和糖尿病非喷他佐辛干预组(DM组,31例)。DM-P组患者于术前30 min静脉输注喷他佐辛0.5 mg/kg。DM组、NDM组在相同时间输注等量生理盐水。分别于术前30 min及术后24 h采集患者非输液侧肘静脉血5 ml,采用ELISA法检测血清中cTnI、降钙素基因相关肽(calcitonin gene-related peptide,CGRP)的浓度;观察记录患者术中不良心血管事件。结果DM组、DM-P组术前30 min、术后24 h血清cTnI浓度显著高于NDM组(P<0.05);DM组术后24 h cTnI显著高DM-P组(P<0.05);与术前比较,NDM组、DM组术后24 h cTnI显著升高(P<0.05),而DM-P组患者术后24 h cTnI显著降低(P<0.05)。术前30 min,NDM组血清CGRP明显高于DM组、DM-P组(P<0.05);术后24 h,NDM组、DM-P组血清CGRP明显高于DM组(P<0.05)。术中不良心血管事件发生率DM组(58.1%)显著高于NDM组(22.6%)(P<0.05)。结论糖尿病患者血清cTnI显著升高,喷他佐辛可降低糖尿病患者下肢手术后24 h血清cTnI浓度。该作用可能与上调CGRP有关。

Objective To evaluate the changes of cardiac troponin I(cTnI)in diabetic patients undergoing lower limb surgery and the effect of pentazocine on the changes.Methods Ninety-three patients who were scheduled for orthopedic surgery in the lower extremity under intrathecal anesthesia were enrolled.They were divided into three groups(n=31):a non-diabetic patient group(group NDM),a diabetic group without treatment of pentazocine(group DM)and a diabetic group with treatment of pentazocine(group DM-P).Patients in group DM-P were intravenously infused with 0.5 mg/kg pentazocine 30 min before operation,while the same volume of normal saline was given in groups DM and NDM.Blood samples were collected 30 min before surgery and 24 h after operation.The serum concentrations of cTnI and calcitonin gene-related peptide(CGRP)were determined through enzyme-linked immunosorbent assay(ELISA).Intraoperative adverse cardiovascular events were recorded.Results Compared with group NDM,groups DM and DM-P showed remarkable increases in the concentration of serum cTnI 30 min before operation and 24 h after operation(P<0.05).Group DM presented marked higher levels of cTnI 24 h after operation than group DM-P(P<0.05).A remarkable increased level of cTnI in groups NDM and DM and a marked decreased level of cTnI in group DM-P were found 24 h after surgery,in comparison with those before surgery(P<0.05).Meanwhile,group NDM presented significantly higher levels of serum CGRP than groups DM and DM-P 30 min before operation(P<0.05).Compared with group DM,groups NDM and DM-P showed remarkable increased levels of CGRP 24 h after operation(P<0.05).The incidence of intraoperative adverse cardiovascular events was significantly increased in group DM(58.1%),compared with 22.6%in group NDM(P<0.05).Conclusions The level of serum cTnI is significantly increased in diabetic patients.Pentazocine can reduce the serum concentration of cTnI in diabetic patients 24 h after lower extremity surgery,which may be associated with the up-regulation of CGRP.