脂肪乳预处理对大鼠静脉注射布比卡因与罗哌卡因致心脏毒性的影响

The effects of pretreatment with lipid emulsion on bupivacaine,ropivacaine infusion induced cardiac toxicity in rats

目的:研究脂肪乳对布比卡因、罗哌卡因导致的大鼠心脏毒性的影响,并初步探讨其机制。方法:SD成年雄性大鼠72只,体重200～280g,随机分为5组,空白对照组(A组,n=8)、布比卡因对照组(B组)、布比卡因+脂肪乳组(C组)、罗哌卡因对照组(D组)、罗哌卡因+脂肪乳组(E组),B、C、D、E每组再分为致死组(1组)和取材组(2组)(每组n=8)。A组经大鼠静脉泵入0.9%氯化钠溶液3ml/(kg·min),6min后开胸取心,B、C、D、E组大鼠经静脉泵入0.9%氯化钠溶液或脂肪乳3ml/(kg·min),共5min,再以2mg/(kg·min)速度泵入相应的局麻药,取材组泵入局麻药1min开胸取心肌,致死组泵入局麻药致心跳停搏。持续监测平均动脉压和心率,记录大鼠出现心律失常、心跳停止的时间及各对应时相局麻药的累积剂量,A组及取材组测心肌ATP含量。结果:C1组出现心律失常和心跳停止的时间比B1组明显延迟、布比卡因用量大于B1组,差异均有统计学意义(P<0.001),而D1组与E1组之间差异无统计学意义。各组心肌ATP酶含量比较,A组>D2组>C2组>B2组,任意两组比较差异均有统计学意义(P<0.001),而D2、E2组之间差异无统计学意义。结论:脂肪乳能够减轻布比卡因的心脏毒性,其机制可能与增加心肌ATP含量有关,但脂肪乳对罗哌卡因的心脏毒性无明显作用。

Objective：To investigate the effect of lipid emulsion on bupivacain,ropivacain infusion induced cardiac toxicity and to explore its mechanism.Methods：72 SD adult male rats weighting about 200-280 g were randomly divided into five groups,non-treatment control group（group A,n=8）,bupivacaine control group（group B）,bupivacaine＋ lipid emulsion pretreatment group（group C）,ropivacain control group（group D）,ropivacain＋lipid emulsion pretreatment group（group E）,each group of B,C,D,E group are divided into two sub-groups based on the death group（group 1） and the material group（group 2）（n=8 each）.Group A,normal saline 3 ml/（kg·min） was pumped in intrvenous injection heart was removed after 6 minutes.Group B,C,D,E,normal saline or lipid emulsion 3 ml/（kg·min） was pumped in 5 minutes,then local anesthetic 2 ml/（kg·min） was pumped in intravenous injection.Local anesthetic was pumped in 1 minute then the heart was removed in group 1,local anesthetic was not pumped in until cardiac arrest in group 2.MAP,ECG and HR were monitored,the time points arrhythmia（QRS≥90 ms）,asystol was recorded and the amount of local anesthetic infused was calculated.ATPase would be measured with the cardiac muscle in the group A and the material group.Results：The time points,arrhythmia and cardiac arrest about group C1 were remarkably later than the group B1.The amount of bupivacaine in group C1 was larger than in group B1,the difference had statistical significance（P0.001）,but there was no statistic difference between group D1 and group E1.The comparison between each groups ATPase,group A〉group D2〉group C2〉group B2,the differences were significant（P〈0.001）,but there was no statistic difference between group D2 and group E2.Conclusion：The mechanisms of the lipid emulsion reduce the cardiac toxicity of bupivacaine may be due to increase contene in myocardial ATPase,the lipid emulsion is able to reduce the cardiac toxicity of bupivacaine in rats,but has no effects on that of ropivacaine.