The Effect Of Low-dose Nitroglycerin On Oxidative Stress In Patients With Hypertension Undergoing Laparoscopic Gynecological Surgery

Objective:The effects of oxidative stress and Apelin-12 levels in hypertensive patients undergoing laparoscopic total hysterectomy were investigated by low-dose nitroglycerin intervention.Methods:According to the approval of the ethics committee of the Second Hospital of Shanxi Medical University,a total of 98 patients with hypertension who planned to undergo laparoscopic total hysterectomy under general anesthesia in our hospital from January to July 2021 were selected,according to the inclusion criteria and exclusion criteria,40 cases in nitroglycerin group and control group were selected by random number table method.The nitroglycerin group was pumped with a low dose(non-hypotensive dose)of nitroglycerin 0.1-0.25μg/kg/min from the beginning of pneumoperitoneum to the end of the surgery,while the control group was pumped with the same amount of normal saline.ST-T changes,MAP and HR data were recorded at five-time points before operation(T0),at the beginning of pneumoperitoneum(T1),30 min at the beginning of surgery(T2),at the end of pneumoperitoneum(T3)and 1h after surgery.Peripheral elbow venous blood was extracted to determine the levels of IL-6,Ang-Ⅱ and Apelin-12 in serum by enzyme-linked immunosorbent assay(ELISA),and statistical analysis was performed.Results:1 There was no statistically significant difference in general data between the two groups,which was comparable(P>0.05).2 Compared to the group: With the prolongation of the operation time,serum IL-6and Ang-Ⅱ levels gradually increased,while Apelin-12 levels gradually decreased,there were statistically significant differences between T0 and T1,T0 and T2,T0 and T4,T2 and T4(P<0.05),there was no significant difference between T3 and T4 pairwise(P>0.05);There was no significant pairwisa difference between MAP and HR at T0,T2 and T4(P>0.05),but increased at T1 and T3,with statistical differences compared with other time pionts(P<0.05).3 Compared between groups: Serum IL-6 and Ang-Ⅱ levels had no statistical significance at T0 and T1(P>0.05),but had statistical significance at T2,T3 and T4(P<0.05);Compared with the control group,after the onset of pneumoperitoneum,the elevation of IL-6 and Ang-Ⅱ serum level decreased significantly,and the level of serum Apelin-12 decreased significantly in NTG group.IL-6,Ang-Ⅱ and Apelin-12 all had different grouping and time interaction effects.There was no significant difference in the incidence of MAP,HR and ST-T abnormalities at five time points(P>0.05).Conclusion:As an exogenous donor of NO,nitroglycerin can relieve the stress response of patients with hypertension during laparoscopic total hysterectomy,Apelin-12 may cooperate with NO to delay the occurrence and development of oxidative stress.These results provided a new clinical idea for reducing the perioperative risk of patients undergoing endoscopic surgery with the cardiovascular diseases.