肾上腺素对脂肪乳剂复苏布比卡因所致离体心脏停搏效果的影响

Effect of epinephrine on lipid based resuscitation in reserving bupivacaine-induced asystole in isolated rat hearts

目的探讨肾上腺素对脂肪乳剂复苏布比卡因所致离体心脏停搏效果的影响.方法24只雄性SD大鼠按随机数字表法分为实验组和对照组,每组12 只,制作Langendorff 离体心脏灌流模型,以100μmol/L布比卡因诱导心脏停搏后继续灌注3min,对照组采用含有2%脂肪乳剂和100μmol/L 布比卡因的灌流液,实验组采用含有0.15μg/ml 肾上腺素和2%脂肪乳剂以及100μmol/L 布比卡因的灌流液.记录离体心脏首个心搏时间（Te）、复跳时间（Tr）以及复跳后1（T1）、5（T2）、10（T3）、20（T4）、30（T5）和40min（T6）的心率（HR）、左室发展压（LvdevP）以及心率左室发展压乘积（RPP）,并进行组间比较.结果实验组的Te 和Tr 均短于对照组（均P〈0.05）.实验组HR、LvdevP 和RPP 在复跳后T1-T2高于对照组（均P〈0.05）.复跳后T3-T6,两组间心功能差异均无统计学（均P〉0.05）.结论肾上腺素可以缩短脂肪乳剂解救临床浓度布比卡因所致离体心脏停搏复苏时间,并且可以增强复跳后初期（复跳后5min 内）离体心脏心功能,但是对复跳后期心功能无明显作用.

Objective To investigate the effect of epinephrine on lipid based resuscitation in reserving bupivacaineinducedasystole in the isolated rat hearts. Methods Twenty-four male Sprague-Dawley rats were randomly divided into twogroups （n=12 in each group）, the Langendorff isolated heart perfusion model was used and a continuous infusion of 100μmol/Lbupivacaine was conducted until the asystole was induced for 3min. Then the solution containing 2%lipid emulsion and 100mol/Lbupivacaine was perfused in control group, and the solution containing 0.15μg/ml epinephrine, 2% lipid emulsion and 100μmol/Lbupivacaine was perfused in experiment group. The time of first heart beat （Te）, resuscitation time （Tr）, heart rate （HR）, leftventricular developed pressure（LvdevP） and heart rate-pressure product （RPP） of the isolated hearts at 1min（T1）, 5min（T2）,10min（T3）, 20min （T4）, 30min （T5） and 40min （T6） during recovery phase were recorded. Results Te and Tr in the experimental groupwere shorter than those in the control group（P〈0.05）. The HR, LvdevP and RPP in the experimental group were higher than thosein the control group from T1 to T2 after re-beating（P〈0.05）. The heart function in two groups had no statistical difference from T3 toT6（P 〉0.05）. Conclusion Epinephrine can shorten the resuscitation time of lipid based resuscitation in reserving bupivacaineinducedasystole, and can also enhance the function of isolated heart during the first 5 min after re-beating, but had no significanteffect on the heart function in the later stage of recovery phase.