脂肪乳剂预处理对布比卡因心脏毒性的影响

Effect of Lipid Emulsion Pretreatment on Cardiovascular Toxicity of Bupivacaine

目的研究脂肪乳剂预处理对布比卡因致新西兰大白兔心脏毒性的影响及机制。方法 14只新西兰大白兔随机均分为2组,A组给予乳酸林格液,B组给予脂肪乳注射液20%英脱利匹特预处理,然后微量泵持续输注0.75%布比卡因3mg/(kg.min)至动脉压力波为直线,观察心脏不良事件发生的时间和测量心肌布比卡因的浓度。结果出现室性心律时间B组为(108.1±24.8)s,显著延后于A组[(50.4±10.4)s,P=0.000];心脏完全停搏时间B组为(722.6±191.9)s,显著延后于A组[(347.1±66.2)s,P=0.002];布比卡因的总用量B组为(36.1±9.6)mg/kg,显著高于A组[(17.4±3.3)mg/kg,P=0.002]。A组和B组心肌布比卡因浓度分别为(151.6±197.7)μg/g和(130.7±24.9)μg/g,差异无统计学意义(P=0.109)。结论脂肪乳剂预处理能降低布比卡因的心脏毒性,主要作用机制可能是脂肪池效应。

Objective To investigate the effect of lipid emulsion pretreatment on bupivacaine cardiotoxicity and its main mechanism.Methods Fourteen New Zealand white rabbits were randomly divided into 2 groups（n=7 each）.Group A was pretreated with lactate ringer solution and group B 20% Intralipid,and then accepted micro pumps continuous infusion of 0.75% bupivacaine 3 mg/（kg·min） until the arterial wave turned to a straight line.The adverse cardiac events and myocardial concentration of bupivacaine were observed.Results Ventricular arrhythmia was observed in group B at（108.1±24.8）s,which was significantly longer than（347.1±66.2）s in group A（P=0.000）.Cardiac arrest was observed in group B at（722.6±191.9）s,which was significantly longer than（347.1±66.2）s in group A（P=0.002）.Total usage of bupivacaine was（36.1±9.6）mg/kg in group B,which was significantly higher than（17.4±3.3）mg/kg in group A（P=0.002）.Intralipid significantly delayed the onset of ventricular arrhythmia（P=0.000） and postponed the beginning of arterial wave turning to a straight line（P=0.002） in group B.Total dosage of bupivacaine in group B was significantly higher than group A（P=0.002）.The cardiac bupivacaine concentration was（151.6±197.7）μg/g and（130.7±24.9）μg/g in group A and B and there was no significant difference（P=0.109）.Conclusion Lipid emulsion pretreatment can reduce cardiac toxicity of bupivacaine and the possible main mechanism is the ＂lipid pool＂ effect.