The Relationship Between Hemoglobin A1c Preoperative And Perioperative Cardiovascular Events In Diabetes Mellitus

Objective:To observed the plasma concentration of neuropeptide Y(NPY), substance P(SP),calcitonin gene-related peptide(CGRP), cardiac troponin I(c Tn I) in diabetic patients receiving lower limb surgery and the occurrence of perioperative cardiovascular events(PCE).To investigate the relationship between hemoglobin A1 c and perioperative cardiovascular events(PCE) in diabetes and the possible mechanism.Methods:50 inpatients with subarachnoid block receiving lower limb surgery in our hospital from July 2015 to December 2015 were divided into non-diabetes mellitus group(DM group, C group, n=20) and diabetes mellitus group(DM group, n=30).According to the level of Hb A1 c, the DM group were divided into Hb A1c<6.5% group(A group, n=13) and Hb A1c≥6.5% group(B group, n=17).Blood pressure, heart rate, heart rhythm,electrocardiogram during operative and perioperative cardiovascular events were recorded.Preoperative, postoperative and 24 h postoperative plasma contents of NPY, SP, CGRP and c Tn I were detected by enzyme-linked immunosorbent method.Results:Incidence of perioperative cardiovascular events of Hb A1c≥6.5% group was remarkably greater than that of Hb A1c<6.5% group(P<0.05);Cardiovascular events group had much higher plasma NPY level than non-cardiovascular events group preoperative(P<0.05); Cardiovascular events group had much lower plasma SP,CGRP level than non-cardiovascular events group preoperative(P<0.05);The plasma NPY and c Tn I contents of Hb A1c≥6.5% group was significantly higher than Hb A1c<6.5% and NDM group(P<0.05);Preoperative, postoperative and 24 h postoperative plasma contents of SP in NDM group was higher than Hb A1c<6.5% and Hb A1c≥6.5% group(P<0.05); The plasma CGRP contents of NDM group was higher than Hb A1c<6.5% and Hb A1c≥6.5%group(P<0.05);The content of c Tn I in Hb A1c≥6.5% group at 24 h post-operation was obviously higher than it before the surgery(P<0.05).Conclusion:High HbA1 c levels will increase the risk of perioperative cardiovascular events in diabetes mellitus, and that maybe was correlated with higher plasma NPY, c Tn I contents and lower plasma SP, CGRP contents. It is helpful for the decrease of incidence of cardiovascular events by intensifying blood sugar control in the perioperative period.