脂肪乳剂复合肾上腺素对布比卡因诱发兔心脏停搏的复苏效果

Resuscitation of bupivacaine-induced cardiac arrest with lipid emulsion combined with epinephrine in rabbits

目的评价脂肪乳剂复合肾上腺素对布比卡因诱发兔心脏停搏的复苏效果。方法雄性新西兰大白兔24只，体重2．0～2．5kg，随机分为4组（n=6），麻醉下行气管插管，开胸暴露心脏，麻醉给药后60min，经耳缘静脉注射布比卡因10mg／kg，心跳停搏后行胸内心脏按压，限定按压时限30min，同时Ⅰ组静脉输注乳酸钠林格氏液8ml／kg10min；Ⅱ组静脉输注长链脂肪乳剂8ml／kg10min；Ⅲ组静脉输注乳酸钠林格氏液8ml／kg10min，同时静脉注射0．1％肾上腺素25μg／kg后静脉输注0．1％肾上腺素120min，维持MAP80～90mmHg；Ⅳ组静脉输注长链脂肪乳剂8ml／kg10min，同时静脉注射0．1％肾上腺素25μg／kg后静脉输注0．1％肾上腺素120min，维持MAP80～90mmHg。肾上腺素极量为8μg·kg^-1·min^-1。记录开始复苏后30min内和120min内兔生存情况，记录Ⅲ组和Ⅳ组肾上腺素用量。结果Ⅰ组和Ⅱ组复苏全部失败。与Ⅲ组比较，Ⅳ组开始复苏后120min内的生存率升高，生存时间延长，肾上腺素用量降低（P〈0．05或0．01）。结论脂肪乳剂不仅可有效复苏布比卡因诱发的兔心脏停搏，还可降低肾上腺素用量。

Objective To investigate the resuscitation of bupivacaine-induced cardiac arrest with lipid emulsion （LE） combined with epinephrine （EP） in rabbits. Methods Twenty-four male New Zealand rabbits weighing 2.0-2.5 kg were randomly divided into 4 groups （n = 6 each）： group Ⅰ lactated Ringer＇s solution （LR） ; group Ⅱ LE; group Ⅲ LR ＋ EP and group Ⅳ LE ＋ EP. The animals were anesthetized with 20% urethane 1.0-1.2 g/kg, tracheostomized and mechanically ventilated （VT 15-18 ml/kg, RR 40 bpm, FiO2 100% ）. Right femoral artery was cannulated. ECG, MAP and PETCO2 were continuously monitored. Thoracotomy was performed and heart was exposed. 0.75% bupivacaine 10 mg/kg was infused iv over 6 min. At the end of bupivaeaine iofusion, LR and LE 8 ml/kg were infused over 10 min in group Ⅰ and Ⅱ respectively. A bolus of 0. 1% epinephrine 25 μg/kg was given iv followed by 0.1% EP infusion to maintain MAP at 80-90 mm Hg in addition to LR or LE infusion in group m and Ⅳ. The amount of EP （in group m and Ⅳ ） and the outcome of resuscitation were recorded. Results Resuscitation failed in all animals in group Ⅰ and Ⅱ . Survival rate was significantly higher, survival time longer while the amount of EP was significantly lower in group Ⅳ than in group Ⅲ. Conclusion Lipid emulsion increases the survival rate of resuscitation of bupivacaine-induced cardiac arrest in rabbits and reduces the amount of epinephrine needed.