The Influence Of Trachea Intubating In General Anesthesia On The Plasma Substance P And The Blood Pressure Of Diabetes And (or) Hypertention Patients

Objective:By observing the changes of plasma substance P(SP) and the blood pressure during tracheal intubation on diabetes and(or) hypertention patients, to disscuss the possible relation between plasma SP and the change of blood pressure,and the respond of diabetes and(or) hypertention patients to stressful event.Methods:Select 60 ASAⅠorⅡpatients undergoing the selective Laparoscopic Vaginal Hysterectomy(LAVH).To devide them into 4 groups according to if they were diabetes and(or) hypertention patients:group C(control group),group DM(diabetes patients only),group HBP(hypertention patients only) and group DM-HBP(diabetes and hypertention patients),every group contained 15 patients.The sufficient completion of preoperative preparation was necessary,especially in the diabetes and(or) hypertention patients.Recording the detail general information of all patients and the course,therapy and complication of the diabetes and(or) hypertention.Total intravenous anesthesia and fast induced endotracheal intubation were selected,and the model of breathing machine was IPPV.Monitoring the ECG,HR,SBP/DBP,SPO2,BIS,PETCO2 sostenuto.Regulating the breathing parameter according to the PETCO2 and airway pressure.Propofol and Remifentanil were chosen during anesthesia.Regulate the depth of anesthesia and add Sufentanil and Vecuronium according to surgical procedures,BIS and the degree ofmuscle relax.Record the special drugs used,operation time,blood loss volume,fluid input volume,urine volume.Monitor SBP/DBP,HR,plasma SP at 10 min before intubation(T1),5min after intubation(T2),5min after tracheal extubation(T3).Results:The comparison in plasma SP:the plasma SP was significantly lower in group DM/HBP/DM-HBP at all time points than group C;the levels of SP at T2 were significantly higher than those at T1 within every group(P<0.05);and there was no significant difference at T2、T3(P>0.05).The Δsp%{(SPT2-SPT1)/SPT1} was highest in group C(P<0.05).The comparison in SBP:the SBP at T2 of every group was significantly higher than it at T1(P<0.05);and there was no significant difference in SBP at T2 and T3(P>0.05).According to the elevated level of SBP at T2(≥20% or not),deviding the patients into 2 groups:group H(≥20%) and group NH(<20%);the statistical analysis showed the levels of plasma SP were significantly lower than those in group NH(P<0.05),and the proportion of diabetes and(or) hypertention patients was 88.6% in group H,which was significantly higher than that in group NH(44%, P<0.05).Conclusion:The levels of plasma SP decrease significantly because of the diabetes and(or)hypertention,and the ability to maintain blood pressure stable is weaken.On the one hand,we should prevent harmful stress during surgery and anesthesia,especially in the diabetes and(or) hypertention patients.On the other hand,the result provides reference for inventing the substitution of SP.