脂肪乳剂对左旋布比卡因致离体豚鼠心脏停跳的复苏作用

Effect of lipid emulsion on resuscitation of levobupivacaine-induced cardiac arrest in isolated guinea pig heart

目的探讨脂肪乳剂及其联合应用肾上腺素或血管加压素对左旋布比卡因中毒的离体豚鼠心脏停跳的复苏作用。方法 24只豚鼠随机分成4组,建立Langendorff离体心脏灌注模型,用300μmol/L左旋布比卡因灌注离体豚鼠心脏使之停跳后,分别应用台氏液(T组)、0.2%脂肪乳剂(L组)、0.2%脂肪乳剂联合0.5μg/mL肾上腺素(LE组)、0.2%脂肪乳剂联合7.5U/L血管加压素(LV组)灌注使之复跳,记录各组灌注后从心脏停跳至恢复窦性心律的时间(复跳时间)以及复跳稳定后2min时的心率、心肌收缩力、冠状动脉流量、心电图PR间期,并在透射电子显微镜下观察左心室心肌超微结构的改变。结果与T组相比,L组的复跳时间显著缩短(P<0.05)。与L组相比,LE组的复跳时间显著缩短(P<0.05),冠状动脉流量显著增加(P<0.05)。LV组与L组间各项指标的差异均无统计学意义(P值均>0.05)。与T组相比,L组的心肌组织线粒体损伤减轻。结论脂肪乳剂有加快左旋布比卡因中毒的离体豚鼠心脏恢复窦性心律的作用,肾上腺素对其作用有促进效果,但血管加压素对其并无明显影响,脂肪乳剂对复苏心肌组织的损害程度也有减轻作用。

Objective To investigate the effects of the lipid emulsion and lipid emulsion combined with epinephrine or vasopressin on resuscitation of levobupivacaine-induced cardiac arrest in isolated guinea pig heart. Methods Twenty-four guinea pigs were randomly divided into 4 groups （n=6 in each group）. After Langendorff isolated heart model was established, 300 μmol/L revobupivacaine was infused into the heart and sustained till asystole. After that, Tyrode’s solution （T group）, 2% lipid emulsion （L group）, 2% lipid emulsion with 0.5 μg/mL epinephrine （LE group）, and 2% lipid emulsion with 7.5 U/L vasopressin （LV group） were perfused respectively to the hearts of corresponding groups. The duration from the beginning of asystole to sinus rhythm, heart rate 2 min after sinus rhythm, myocardial contractility, coronary artery flow and PR interval were recorded at 2 min to sinus rhythm. Transmission electron microscopy was used to examine the myocardial ultrastructure.Results The time from the beginning of asystole to sinus rhythm was significantly shorter in L group than that in T group （P〈 0.05）. Compared to L group, the recovery time was shorter and coronary artery flow was higher in the LE group. There was no significant difference in the heart rate, myocontractility, coronary artery flow or PR interval between the LE group and the T group （P〉0.05）. And also no significant difference was found between L group and LV group. Compared with the T group, the L groups had reduced myocardial mitochondrial damage. Conclusion Lipid emulsion accelerates the resuscitation of levobupivacaine-induced cardiac arrest to spontaneous contractions, and epinephrine, not vasopression, can improve the effect. Lipid emulsion can also attenuate the damage on myocardial tissue.