脂肪乳对布比卡因致家犬心脏毒性救治的疗效评价

Evaluate lipid emulsion in resuscitating the cardiac toxicity caused by bupivacaine in dogs

目的观察脂肪乳(LE)以及LE联合肾上腺素(EPI)在救治布比卡因所致家犬心脏毒性时的疗效评价。方法健康成年家犬21只,均分为三组:20%LE组(L组),20%LE+EPI(C组)和生理盐水组(S组)。0.75%布比卡因10mg/kg匀速经股静脉推注,待MAP降至基础值的50%及ECG出现宽大畸形QRS波时行心肺复苏术(CPR),同时分别给予L组20%LE4ml/kg,C组20%LE4ml/kg+EPI10μg/kg,S组生理盐水4ml/kg。测定和记录造模前(基础值,T0)、造模成功时(T1)、造模成功后5min(T2)、10min(T3)、15min(T4)、20min(T5)时的MAP、HR及PR间期、QRS间期、QT间期的变化,并记录三组家犬在不同时点自主循环恢复(ROSC)的数量。结果 T2时L组和S组家犬ROSC明显低于C组(P<0.05),T3时L组家犬的ROSC数量略多于C组和S组,但差异无统计学意义,T4、T5时明显多于C组和S组(P<0.05)。T5时L组家犬MAP明显高于、HR明显快于C组和S组(P<0.05或P<0.01),PR间期、QRS间期、QT间期明显短于C组和S组(P<0.05或P<0.01)。结论成功建立布比卡因心脏毒性的模型,用LE救治能明显提高家犬的生存率,且救治后的血流动力学指标明显优于LE联合EPI的效果。

Objective To compare effectiveness of Lipid Emulsion （LE） with combination of LE and Epinephrine （EPI） for the treatment of severe hemodynamic compromise owing to bupivacaine （Pup） intoxication in dogs. Methods Twenty-one dogs, divided into three groups were investigated. Bupivacaine, 0.75%, 10 mg/kg, was ad ministered intravenously through femoral vein over 10 s to fasted dogs under pentobarbital sodium induced general anesthesia, with spontaneous breath. Resuscitation started when MAP dropped to 50% of the base value and ECG showed abnormal QRS waves. Then animals were given mechanical ventilation with 100% oxygen and external chest compressions followed by saline （group S）, 20% LE （group L） or 20%LE plus 10 μg/kg epinephrine （group C） infusion, EPI was repeated every 5 rain, saline or 20% LE were ad ministered as a 4 ml/kg bolus followed by continuous infusion at 0.25 ml. kg-1· min-1 until the CPR ended. Survival ratio, hemodynamic changes including MAP, HR, PR duration, QRS duration and QT duration were recorded. Results Six in group L and one in groups S and C survived. The amount of ROSC in group L was a little bit more than groups S and C at T3 without difference, and was significantly higher than that of other two groups after 20 minutes resuscitation （P〈0.05）. MAP and HR in group L was significantly higher than in groups C and S （P〈0.05 or P P〈0.01）, and the PR duration, QRS duration and QT duration in group L were significantly shorter than that of other two groups at T5 （PP〈0.05 or PP〈0.01）. Conclusion Cardiac toxicity model induced by bupivacaine was successfully built up. For the treatment of severe hemodynamic compromise owing to bupivacaine intoxication in dogs, IrE was more effective than LE combined with epinephrine with regard to survival ratio as well as hemodynamic parameters.