| Objective: In this study to observe whether intraoperative application pursuant to the adr can lighten the elderly patients with diabetes, lower limb tourniquet operation produce secondary myocardial injury caused by ischemia-reperfusion injury.Methods: 80 cases of elderly patients under general anesthesia were accepted lower limb orthopedic surgery(operation time>2h). The inhalational general anesthesia has been used and the antioxidant drugs have been deactivated preoperative week. The selected patients were randomly assigned into digital diabetes edaravone group(E1,n=20, non-diabetic edaravone group(E2, n=20), non-diabetic edaravone group(C1,n=20) and non-diabetic non-edaravone group(C2,n =20). After induction of anesthesia, the test group E1 and E2 group were continuous injected of edaravone 60mg(0.9% saline diluted to 100ml), the control group C1 and group C2 were continuous injected of 0.9% saline 100 ml. Both groups were finished in 30 min drops. All groups were observed and recorded before the tourniquet(T1), after tourniquet 1h(T2), after tourniquet 15min(T3), after tourniquet 1h(T4) and post-operative 24h(T5). The jugular venous blood was drawn at each time point to determine the mean arterial blood pressure(MAP), heart rate(HR) and blood glucose(BG changes). And the serum interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), brain natriuretic peptide(BNP) concentration were deter-mined by enzyme-linked immunosorbent assay method(ELISA). The concentration of malondialdehyde(MDA) was determined by thiobarbituric Acid Determination. The concentration of creatine kinase isoenzyme(CK-MB) was measured by immunosorbent assay. The concentration of troponin I(c Tn I) was measured by chemiluminescence immunosuppression. While the patient awake extubation time, Back ICU stay and postoperative hospital stay were recorded. The SPSS15.0 statistical software was used for statistical analysis, measurement data were presented as mean±standard deviation, the measure-ment data using a randomized block design ANOVA, repeated measures design The measurement data using analysis of variance, measurement data using chi-square test.Results: The awake extubation time, postoperative ICU stay and hospital stay time of the patients in diabetics edaravone group were shorter than the non-diabetic group edaravone(P<0.05); Compared with nondiabetic edaravone group, the non-diabetic with non-edaravone group was also shorter, there was a significant difference(P<0.05). Comprehensive comparison of postoperative recovery in each group, we could found that in non-diabetic edaravone group> non-diabetic non-edaravone group> Diabetes edaravone group> edaravone group of non-diabetic. Intraoperative each time point, the flow of blood markers in diabetic patients after anesthesia MAP, HR, and BG levels were significantly higher than non-diabetic patients(P<0.05). After tourniquet 1h(T2), diabetes edaravone group MAP, HR were significantly lower than that of non-diabetic edaravone group(P<0.05). The blood glucose levels during surgery in all patients at each time point showed no significant change(P>0.05). Compare the perioperative serum Center muscle injury factor of patients, such as BNP, CK-MB, c Tn I, TNF-α, IL-6 and MDA, we could found that the expression levels of diabetic patients were higher than those of non-diabetic patients at each time point, with a significant difference(P<0.05). The postoperative diabetes edaravone group were significantly lower than the index of non-diabetic edaravone group(P<0.05). The expression of nondiabetic edaravone group at each time point were significantly lower than the non-diabetic non-edaravone group, with a statistically significant difference(P<0.05).Conclusion: The edaravone could effectively inhibit lipid peroxidation and reduce muscle damage in patients by reducing the central factor in serum, such as the BNP, CK-MB, c Tn I, TNF-α, IL-6 and MDA. It could reduce the myocardial ischemia-reperfusion injury. It could be used as a new type of drug to improve outcomes in elderly patients after lower limb surgery in clinical myocardial protection. |
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