The Effect Of The Pretreatment With Pentazocine On Myocardial Injury Induced By Lower Limb Surgery In Diabetic Patients

Objective:This study was to determine whether pentazocine pretreatment can reduce myocardial injury which induced by lower limb ischemia reperfusion in diabetic patients,and the relevance with calcitonin gene related peptide(CGRP).Methods:Choose patients undergoing unilateral knee replacement surgery,30 patients without diabetes(N group,n=30)and combination of 60 cases with type 2 diabetes,ASA I ~ II,all patients performed the procedure under spinal anesthesia.Randomization of diabetic patients(by random number table method)was divided into two groups: Pentazocine pretreatment group(group P,n=30)and saline control group(group C,n=30).Before the lower extremity tourniquet was inflated,patients in group P were given the injection of pentazocine(0.5mg/kg into 100 ml of 0.9% saline),group N and group C were given the same amount of normal saline 100 ml.At the moment of before flooding blood before operation(T0),before tourniquet is deflated(T1),immediately after tourniquet be deflated(T2),1 hour after pine tourniquet(T3),24 hours after operation(T4),recorded the patients' vital signs,including heart rate(HR),mean arterial pressure(MAP),pulse oxygen saturation(SPO2),statistical tourniquet inflation time,the whole volume of transfusion and blood loss for the procedure.Respectively in T0,T3 and T4,5ml blood was collected from nontransfusion side elbow vein.using enzyme-linked immunosorbent experiment(enzyme-linked immunosorbent assay,ELISA)method to detect the serum content of cardiac troponin I(cTnI)and CGRP.Results:There was no statistically significant difference between the three groups in clinical general indicators,operative time,tourniquet inflation time,whole blood loss and transfusion volume(P>0.05).The results of hemodynamic comparison: different points in each group was compared with T0 point,the heart rate in T2 point rose significantly(P<0.05),no significant difference in MAP and SpO2 in three groups(P>0.05).Serum index results: Compared with T0 point,different point of cTnI values in each group were higher,T3 and T4 point values increased(P<0.05),more obvious in T4 point(P<0.05).In group P,the values decreased at T3 and T4 points(P<0.05),lower than that of C group.Compared with T0 point,the values of CGRP in group P and group C were significantly higher at T3 and T4 time points(P<0.05);Compared with group C,the CGRP value of T3 and T4 in P group was significantly higher than that in group C(P<0.05).Conclusion:The level of serum cTnI in type II diabetic patients with limb ischemia-reperfusion was reduced by pretreatment with pentazocine,and the serum CGRP concentration was increased,which resulted in certain myocardial protective significance.