脂肪乳对布比卡因中毒大鼠心肺复苏后心脏功能的作用

Effect of Lipid Emulsion on Cardiac Function Following Cardiac Arrest Induced by Bupivacaine Intoxication

【目的】研究脂肪乳在布比卡因诱导大鼠的心跳骤停心肺复苏的应用,探讨脂肪乳是否能减弱布比卡因中毒后的心脏毒性。【方法】24只SD大鼠,随机分为2组:A组:对照组(n=12),B组:脂肪乳组(n=12)。将大鼠麻醉后静脉注射布比卡因20 mg.kg-1,心跳停搏后行心肺复苏(CPR),间断注入肾上腺素。A组随即注入生理盐水5 mL.kg-1,后持续静脉注入生理盐水;B组注入20%脂肪乳5 mL.kg-1后持续静脉注入脂肪乳0.25 mL.kg-1.min-1。监测心率、血压和直肠温度。在麻醉后、复苏成功5 min,30 min用超声探头测量心脏指标。在麻醉后、恢复自主循环后1 h、6 h测血乳酸、血糖、TNF-α,IL-1β,IL-6。【结果】A组心肺复苏成功7只(58%),B组复苏成功10只,(83%),B组成功率高(P<0.05)。两组复苏后心率正常。复苏后30 min,B组的收缩压比A组高,均在正常范围。复苏后30 min B组大鼠心脏的射血分数、每搏输出量和心脏指数比A组高(P<0.05)。复苏后A组的血糖、血乳酸比B组高(P<0.05)。复苏后1、6 h的TNF-α、IL-1β、IL-6两组之间无统计学差异。【结论】布比卡因中毒心跳骤停的大鼠用脂肪乳联合肾上腺素比单纯肾上腺素心肺复苏心脏功能恢复较快,且有较高的复苏成功率。

[ Objective ] To investigate the effect of lipid emulsion on cardiac function following cardiac arrest induced by bupivacaine intoxication. [Methods] Twenty-four SD rats were randomly divided into 2 groups. Group A applied epinephrine （n = 12）; Group B applied lipid emulsion combinding epinephrine （n = 12）. The rats were administered bupivaeaine 20 mg·kg^-1. Cardiopulmonary resuscitation （CPR） was started. Epinephrine were administered. Normal saline 5 mL·kg^-1 were administered in group A. 20% Lipid emulsion 5 mL·kg^-1 and 0.25 mL.kg^-1.min^-1 were administered in group B. The heart rate, blood pressure, and temperature were monitored. Echocardiography was checked at 5 min and 30 min after restoration of spontaneous circulation （ROSC）. The lactate, glucose, TNF-α, IL-1β, and IL-6 were detected before cardiac arrest, 1 h and 6 h after ROSC. [Results] Seven rats （58%） and 10 rats （83%） were successful resuscitated. The success rate was higher in group B than in group A. There was no difference in heart rate between the two groups. Systolic blood pressure, cardiac index, and ejection fraction was higher in group B than in group A （P 〈 0.05）. Lactate, glucose were higher in group A. There were no difference in 1,6 h TNF-α, IL-1β, and IL-6. [Conclusion] There was higher success rate and better heart function in lipid emulsion combined epinephrine than epinephrine when applied in cardiac arrest induced by bupivacaine intoxication.