脂肪乳剂复苏布比卡因导致的心脏停搏的机制探讨  

The mechanism of lipid emulsion in the resuscitation on bupivacaine-induced cardiac arrest in the isolated rat heart

作　　者：施通[1] 刘乐[1] 施克俭[1] 王权光[1] 陈莺[1] 王方岩[2] 徐旭仲[1] 

机构地区：[1]温州医学院附属第一医院麻醉科,浙江温州325000 [2]温州医学院病理生理学教研室,浙江温州325000

出　　处：《温州医学院学报》2010年第2期119-122,129,共5页Journal of Wenzhou Medical College

摘　　要：目的:探讨脂肪乳剂逆转布比卡因心脏毒性可能的作用机制。方法:SD雄性大鼠72只,随机分成六组:A组(布比卡因致心脏停搏脂肪乳剂复苏组)、B组(布比卡因致心脏停搏K-H液灌注组)、C组(布比卡因致心脏停搏组)、D组(平衡灌注25min组)、E组(含脂肪乳剂的K-H液灌注组)、F组(K-H液灌注组),每组12只。记录灌注期间的心率-左心室发展压乘积(RPP),测定停灌时各组心肌组织腺苷酸含量和布比卡因浓度。结果:A组复跳例数、早期复跳例数均显著多于B组(P<0.01)。A组复跳时间显著短于B组(P<0.05)。复跳后40min内,A组的RPP均显著高于B组(P<0.01)。A组的EC值显著低于B组(P<0.05)。心肌组织中的布比卡因浓度从高到低依次为C组>B组>A组(P<0.01)。结论:脂肪乳剂降低心肌组织布比卡因浓度,是其逆转布比卡因心脏毒性的主要作用机制。Objective： To explore and discuss the possible mechanism of lipid emulsion to rescue the bupivacaine-induced cardiac arrest.Methods： The hearts of male Sprague-Dawley rats were excised and retrogradely perfused in an nonrecirculating Langendorff preparation.They were randomly divided into six groups （twelve hearts per each group）.In group A,B and C,after Krebs-Henseleit buffer （KHB） was perfused for 25 min,100 μ mol/L bupivacaine was perfused until 3 min after asystole.Then 2% lipid emulsion and 30 μ mol/L bupivacaine mixture was perfused in group A ;30 μ mol/L bupivacaine was perfused in group B;perfusion was stoped at that time in group C.In group D,E and F,KHB was perfused for 25 min.Then 2% lipid emulsion was perfused for 40 min in group E ;KHB was perfused for 40 min in group F ;perfusion was stoped at that time in group D.The time from the end of the perfusion with 100 μmol/L bupivacaine to the heart resuscitation （Tr） were compared between group A and B.The cases of recovery （heart beating recovered after the end of the 100 μmol/L bupivacaine perfusion） and the cases of early recovery （heart beating recovered within 3 min after the end of the 100 μmol/L bupivacaine perfusion） were recorded.Rate-pressure product （RPP=heart rate ×[left ventricular systolic pressure-left ventricular diastolic pressure]） during the course of resuscitation in group A and B were monitored.RPP during the course of perfusion in group E and F were monitored.At the end of each protocol,myocardial tissues were taken from the apex of the left ventricle for measuring ATP,ADP,AMP,total adenine nucleotides （TAN） and energy charge （EC）.The concentrations of bupivacaine in myocardial tissues among group A,B,C were also measured.Results： The recovery cases and the cases of early recovery in group A were more than those in group B （P 0.01）.The time of recovery of heart beating in group A was significantly shorter than that in group B （P 0.05）.RPP was significantly higher in group A during

关 键 词：脂肪乳剂 布比卡因 心脏复苏 心脏停博 人工 大鼠 

分 类 号：R614[医药卫生—麻醉学]