咪唑安定拮抗罗哌卡因致惊厥实验研究  

Anticonvulsant action of midazolam on the convulsion induced by ropivacaine overdose

作　　者：杜敏逸[1] 吴新民[1] 马琼[1] 解大建[1] 桂志兰 

机构地区：[1]北京大学第一医院麻醉科,100034 [2]北京大学第一医院动物中心,100034

出　　处：《中华麻醉学杂志》2001年第6期349-351,共3页Chinese Journal of Anesthesiology

摘　　要：目的 了解罗哌卡因引起惊厥时的剂量，对机体的影响及咪唑安定对罗哌卡因致惊厥的拮抗作用。方法 家兔２０只，分成罗哌卡因组（Ｒ）和咪唑安定＋罗哌卡因组（ＭＲ），均在未麻醉下行耳正中动脉、耳缘静脉穿刺置管。经动脉监测ＭＡＰ、ＨＲ，取样测全血乳酸浓度、血气及血浆罗哌卡因浓度。ＭＲ组预先经静脉推注咪唑安定０．８ｍｇ／ｋｇ，两组均以 ０．５ｍｌ／ｍｉｎ 输注０．７５％罗哌卡因至惊厥发作停药。记录抽搐起止时间为惊厥持续时间。结果Ｒ组和ＭＲ组罗哌卡因惊厥阈量分别为4８６ｍｇ／ｋｇ和１２．２６ｍｇ／ｋｇ，惊厥持续时间分别为７．２５ｍｉｎ和８．５９ｍｉｎ，惊厥时动脉血药浓度分别为1１．５２μｇ／ｍｌ和１６．７７μｇ／ｍｌ，罗哌卡因４．８６ｍｇ／ｋｇ对血压、心率影响很小，罗哌卡因１２．２６ｍｇ／ｋｇ使血压下降３１％，心率减慢３５％，停药后逐渐恢复正常，两组动物均无需特殊处理全部存活。ＭＲ组在惊厥过程中能维持动脉血ｐＨ正常，血乳酸水平不升高。结论 罗哌卡因对心血管毒性作用较轻，０．８ｍｇ／ｋｇ咪唑安定可有效预防和治疗罗哌卡因的全身毒性反应，能提高罗哌卡因惊厥阈量２．５倍。Objective To determine the dose of ropivacaine leading to convulsion and the convulsant action of midazolam. Methods Twenty healthy adult rabbits weighing 2.5-3.5kg were randomly divided into two groups with ten animals in each group: ropivacaine group(R) and midazolam-ropivacaine group(MR). Middle artery of ear was cannulated for MAP, HR monitoring and blood sampling for blood gas analysis and determination of plasma lactate and ropivacaine concentrations. Edge vein of ear was cannulated for administration of drugs. In both groups animals received intravenous infusion of 0.75% ropivacaine at a rate of 0.5m1/min until convulsion occurred. In MR group midazolam 0.8 mg/kg was given intravenously before ropivacaine.Results The dose of ropivacaine leading to convulsion was 4.86mg/kg for R group and 12.26mg/kg for MR group. Plasma ropivacaine concentration was 11 .52pg/ml in group Rand 16.77pg/ml in MR group. Convulsion lasted for 7.25 mm(R group) and 8.59mm(MR group) . Plasma lactate concentration increased significantly during convulsion in R group but remained unchanged in MR group. Blood pH decreased significantly during convulsion in R group but there was little change in PaCO2 and PaO2. Blood pH, PaO2 and PaCO2 did not change significantly during convulsion in MR group. There was no significant change in MAP and HR during convulsion in R group. In MR group MAP and HR decreased by 31 % and 35% respectively during convulsion and returned to baseline value gradually after ropivacaine infusion was stopped. All animals survived the experiment in both groups. Conclusions Ropivacaine is less cardiovascular toxic. Pretreatment with 0 . 8mg/kg midazolam greatly increases the dose of ropivacaine leading to convulsion. Midazolam can effectively prevent and treat CNS toxicity of ropivacaine.

关 键 词：酰胺类 咪达唑仑 惊厥 罗哌卡因 局麻药 咪唑安定 

分 类 号：R614[医药卫生—麻醉学] R971.2[医药卫生—外科学]