脂肪乳剂与肾上腺素在布比卡因引起的心脏停搏复苏中具有协同作用

Lipid emulsion synergizes with epinephrine in the resuscitation of bupivacaine induced cardiac arrest

目的探讨脂肪乳剂和肾上腺素在布比卡因心脏停搏复苏中的作用和机制。方法 10~12月龄健康山羊,以静脉注射布比卡因诱导心脏停跳+胸内心脏按压的方法制作山羊在体心脏停搏复苏模型后,随机分为3组:肾上腺素(epinephrine,E)组、脂肪乳剂(lipid,L)组、脂肪乳剂+肾上腺素(lipid+epinephrine,LE)组,每组6只。应用高效液相法检测布比卡因血浆浓度,透射电镜观察复苏后心肌细胞线粒体形态,乳酸脱氢酶组织化学染色观察酶活性。结果与肾上腺素组比较,脂肪乳剂组自主循环恢复时间延长,脂肪乳剂+肾上腺素组自主循环恢复时间缩短;脂肪乳剂组和脂肪乳剂+肾上腺素组布比卡因血浆浓度下降更快,复苏成功率更高,电镜下线粒体空泡样和髓样损伤减少,乳酸脱氢酶活性降低。结论脂肪乳剂与肾上腺素在布比卡因心脏停搏复苏中具有协同作用,其机制可能与促进布比卡因代谢和线粒体保护有关。

Objective To investigate the role and mechanism of lipid emulsion and epinephrine in the resuscitation of cardiac arrest induced by bupivacaine.Methods Eighteen10to12months old healthy goats were randomly divided into three groups with6animals of each:lipid emulsion(L)group,epinephrine(E)group,lipid emulsion+epinephrine(LE)group.Plasma concentrations of bupivacaine were measured by HPLC.The mitochondrial morphology of myocardial cells was observed under electron microscopy.Lactate dehydrogenase staining was used to determine the enzyme activity.Results Compared with group E,while the cardiac resuscitation time in group L was longer,it was shorter in group LE.Group LE had the fastest and most reduction of bupivacaine plasma concentration followed by group L and group E.Similarly,Group LE had least mitochondrial medullary changes and vacuolar degeneration as well as lowest lactate dehydrogenase activity than group L and E.Conclusion Lipid emulsion and epinephrine likely have synergistic effects in the resuscitation of cardiac arrest induced by bupivacaine,which may be related to the promotion of bupivacaine metabolism and mitochondria protection.