脂肪乳剂对布比卡因诱导的离体大鼠心脏停搏的复苏作用

Resuscitation with lipid emulsion on bupivacaine-induced cardiac arrest in the isolated rat heart

目的:观察脂肪乳剂治疗布比卡因诱导的离体大鼠心脏停搏的复苏效应和对复苏后心脏功能的影响。方法:Sprague-Dawley成年雄性大鼠18只,随机分为实验组和对照组。建立Langendorff离体心脏灌注模型。以100μmol/L布比卡因诱导心脏停搏造模后实验组改用含30μmol/L布比卡因及2%脂肪乳剂的K-H液灌注心脏,对照组改用含30μmol/L布比卡因的K-H液灌注心脏。记录两组恢复窦性心律情况,记录停跳前基础值及恢复窦性心律后40 min内的心率、左心室发展压和心率-左心室发展压乘积(RPP)。结果:与对照组比较,实验组心脏恢复窦性心律时间显著缩短(P<0.05),心脏造模成功后3 min内恢复窦性心律的例数实验组显著多于对照组(P<0.01)。恢复窦性心律后,实验组各时间点的心率、RPP均显著高于对照组(P<0.05或0.01)。结论:脂肪乳剂对布比卡因诱导的离体大鼠心脏停搏治疗有效,能加速心脏复苏,改善复苏后心脏功能。

Objective： To observe the effects of resuscitation with lipid emulsion on bupivacaine- induced cardiac arrest in the isolated rat heart. Methods： Eighteen adult male rats were randomly divided into two groups： the intralipid group （n=9） and the control group （n=9） . We used an isolated rat heart, constant-pressure perfused, non-recirculating Langendorff preparation. Infusion of 100 μmol/L bupivacaine was initiated and sustained until 3 min after asystole, then 2% Intralipid emulsion and 30 μmol/L bupivacaine were perfused to the isolated hearts in the intralipid group or 30 μmol/L bupivacaine exclusively in the control group. The time from bupivacaine infusion was initiated to asystole and the time from the end of the 100 μmol/L bupivacaine infusion to return to sinus rhythm between two groups was compared. The cases of early recovery （hearts return to sinus rhythm in 3 min after the end of the 100 μmol/L bupivacaine infusion） and also all the recovery cases （hearts return to sinus rhythm after the end of the 100 μmol/L bupivacaine infusion till the end of our study） were recorded. Heart rate （HR）, left ventricular developed pressure （LVDP= left ventricular systolic pressure-ieft ventricular diastolic pressure） ,rate-pressure product （RPP= heart rate x LVDP） at the baseline and during the course of recovery were monitored. The highest RPP value during 40 min after returning to sinus rhythm （RPPh） and the ratio of RPPh to baseline RPP （RPPr） were recorded. Results： The time of return to sinus rhythm in the intralipid group was significantly shorter than that in the control group （P〈 0.05）. The cases of early recovery were 9 versus 2 （P〈 0.01） for lipid and controls. HR and RPP were significantly lower compared with the baseline during 40 min after returning to sinus rhythm in both groups but they were significantly higher in intralipid group （P〈0.05 or 0.01）. The RPPh and RPPr were significantly higher in intralipid group than those in control group （P〈0.01）. Conclusion： Resuscitation with Lipid emulsion on bupivacaine-induced cardiac arrest results in more rapid return to spontaneous contractions and improves cardiac function during the course of recovery.