Observation And Study Of Constant-speed Pump Injection Of Methoxamine In Diabetic Patients Undergoing Total Knee Arthroplasty After Tourniquet Release

Objective: To evaluate the effects of constant-rate pumping of low-dose methoxamine on hemodynamics,oxidative stress,myocardial injury and Apelin-13 in patients with diabetes mellitus undergoing knee arthroplasty after tourniquet release.Methods: In this study,92 diabetic patients(aged 50-70 years old,ASA grade Ⅱ-Ⅲ)who underwent single knee arthroplasty in the second Hospital of Shanxi Medical University from Dcember 2020 to September 2021 were randomly divided into two groups:group A(experimental group)and group B(control group),46 cases in each group,and then 40 cases(n=40)were drawn from each of the two remaining groups of subjects by the random digital table method according to the criteria of removal.All patients were operated by the same group of skilled orthopedic surgeons under subarachnoid block anesthesia.In group A,after the block level was fixed between T10-T12(excluding the effect of sympathetic block on hemodynamics and indexes),methoxamine was injected intravenously at a constant speed of 2μg /(kg·min);group B was injected with the same amount of normal saline at the same speed and the same speed after the block plane was fixed.Serum cardiactroponin(c Tn T),malondialdehyde(MDA),IL-6 and Apelin-13 levels were measured before(T0),10 min(T1),30 min(T2)after releasing the tourniquet.The chages of T0-T2 heart rate(HR),mean arterial pressure(MAP)and electrocardiogram were more stable,and the ST-T segment changes was observe,and adverse reactions were recorded.Results: The general data of both groups were not ststically significant(P>0.05).Comparison between the two groups: the HR in group B was significantly higher than that in group A at T1(P<0.05),MAP was lower than that in group A at T1 and T2(P<0.05),the changes of ST-T segment and the incidence of adverse reactions in group A were relatively lower(P<0.05);and the levels of serum c Tn T,MDA and IL-6 in group A were lower than those in group B at the same time point,while the levels of serum Apelin-13 in group A was higher than that in group B at the same time point(P<0.05).Comparison within the group: compared with T0,the heart rate in group A decreased at T1 and T2,while that in group B increased significantly at T1 and fluctuated significantly(P<0.05),and the mean arterial pressure increased at T1 in group A,but decreased in group B at T1 and T2(P<0.05),At T1 and T2,the levels of serum c Tn T,MDA and IL-6 increased,while the level of serum Apelin-13 decreased in both groups(P<0.05).Conclusion: Constant speed pump injection of low-dose [2μg /(kg·min)] methoxamine can maintain the hemodynamic stability,inhibit the production of oxidative stress and inflammatory factors and reduce the serum concentration of Apelin-13,and produce myocardial protection in diabetic patients undergoing knee arthroplasty after tourniquet release,which provides a reference for clinical application.