Effect Of Pantazocine On Postoperative Cardiac Troponin ? In Patients With Diabetes Mellitus Undergoing Lower Limb Surgery

Objective:To evaluate the changes of cardiac troponin I(cTnI)in diabetic patients undergoing elective lower limb surgery and the effect of pantazocine on the changes.Methods:Ninety-three patients scheduled for orthopedic surgery in lower extremity under intrathecal anesthesia were enrolled and assigned to three groups,the non-diabetic patient group(NDM,n = 31),diabetic without treatment of pentazocine group(DM,n = 31)and diabetic patients given pentazocine before surgery as DM-P group(n = 31).The patients in the group of DM-P were given intravenous drip of pentazocine(0.5mg /kg in 100 ml of 0.9% saline,in 30 min),before start of operation,while only the same volume of saline was infused intravenously in groups DM and NDM,at the same rate.Blood samples were collected at 30 min before the surgery and 24 hours after the operation.The serum concentrations of cTnI?calcitonin gene-related peptide(CGRP)?substance P(SP)and neuropeptide Y(NPY)were determined using enzyme-linked immunosorbent assay.Intraoperative adverse cardiovascular events(ACVE)were monitored and analyzed.Results:The concentration of cTnI before and 24 hours after the operation were significantly increased in diabetic patients(including DM group and DM-P group),compared with NDM group(P?0.05).However,significantly lower level of cTnI was detected 24 hours after the surgery in the diabetic patients treated with pentazocine,when compared with that of DM group(P?0.05).Compared with pre-operation values,greater levels of cTnI were observed at 24 hours after operation in groups NDM and DM(all P?0.05),but a lower concentration of cTnI in the patients of DM-P group(P?0.01).In the meantime,significantly higher level of CGRP was seen in non-diabetic patients,compared with the concentration of CGRP before and 24 hours after operation in DM group and the concentration of CGRP before operation in DM-P group(all P?0.05).The concentration of CGRP at 24 hours after operation in group DM-P was significantly higher than that of group DM(P?0.05).Compared with NDM group,the concentration of SP before and 24 hours after the operation was significantly decreased in diabetic patients(including DM group and DM-P group)(P?0.05),but the concentration of NPY was increased(P?0.05).There was no statistical difference in the concentrations of SP and NPY before and 24 hours after the operation between DM group and DM-P group(P?0.05)?The incidence of intraoperative adverse cardiovascular events was significantly increased in group DM(P?0.05),compared with NDM group.Conclusion:Compared with non-diabetic patients,the perioperative serum cTnI,the risk of myocardial damage and the incidence of adverse cardiovascular events in diabetic patients were significantly higher than those in non-diabetic patients.Pentazocine can reduce the serum concentration of cTnI at 24 hours in the diabetic patients after the elective lower extremity surgery,which may be associated with the up-regulation of CGRP.