Changes Of Plasma Substance P During Perioperative Period About Diabetes Patients

Objective By observing the changes of plasma levels of substance P(SP),the changes of blood glucose and the fluctuations of hemodynamic in diabetic patients during the perioperative, to investigate the impact of diabetes on plasma SP, the stability of hemodynamic and the influence of SP under stress state.Methods Scheduled elective laparoscopic surgery under general anaesthesia were enrolled in the study. Selected twenty-eight ASA I or II patients without diabetes as the control(C) group. In the diabetes mellitus(DM) group, there were twenty-eight ASA I or II patients who have been diagnosed with type II diabetes by the WHO diagnostic criteria. Included seventeen diabetics with a history of hypertension, Thus, DM group was divided into two sub-groups:diabetics with hypertension (DM-HP), diabetics with normal blood pressure (DM-NBP).Controlled blood glucose and blood pressure before surgery. After entered the operating room, patients with conventional intravenous fluids. All patients were anesthetized with midazolam (0.06mg·kg’1), sufentanil (0.6μg·kg-1),vecuronium (100μg·kg-1) and etomidate (0.3mg·kg-1), vebtilated by anesthetized machine. Continuously infusion of propofol (4-6mg·kg-1·h-1) and remifentanil (10-20μg·kg-1·h-1),supplemented with sufentanil to enhance analgesic and vecuronium was given interruptedly when necessary during operation. SBP,DBP,HR were measured during the perioperative, particularly at the following time points:30minutes before surgery (To)just intubation time(T1)just incision time(T2),15minutes after incision (T3),30minutes after incision (T4),just extubation time(T5). At To,T2,T5time points, vein blood samples were collected to determine the plasma SP and blood glucose. Results1.The changes of plasma SP.(1)The levels of plasma SP in DM group were significantly lower than those in the C group. SP levels in DM-HP patients were apparently lower than those in the C group and DM-NBP group (P<0.05)(2)The levels of SP had no significant difference during perioprative in DM and C group. However, plasma SP had an increasing trend in DM group.2.The changes of hemodynamic and blood glucose.(1)SBP,DBP,HR at T1and T5were significantly increased than preoperative values in DM and C group. At T2, T3, T4, they maintained at a low level. There were no significant difference between DM and C group about hemodynamic.(2)Blood glucose at T2,T5were greatly higher than To. At To,T2,T5time points, blood glucose in DM group were apparently higher than those in the C group.Conclusion1.The levels of SP in diabetics were apparently decreased, which maight be related to the nerve damage caused by diabetes mellitus.2.Plasma SP in DM-HP patients were further reduced, the physiological protective effect of SP may be weakened.3.Stress reaction could affect hemodynamic and elevate blood glucose. However, the changes were in less than20%of basic value, it means that anesthesia could inhibit the stresss reaction.4.The leves of SP have no significant difference during perioprative about DM and DM-HP patients, it maybe related to the inhibition of stress reaction using total anesthesia and small surgical trauma.