脂肪乳用于局部麻醉药中枢神经系统急性毒性反应的救治

The use of lipid emulsion in the treatment of local anesthetic acute systemic toxicity in the central nervous system

惊厥和心律失常是局部麻醉药(local anesthetic,LA)全身急性毒性反应(local anesthetic acute systemic toxicity,LAST)中最易危及生命的急性并发症。脂肪乳(lipid emulsion,LE)预防、治疗LA急性毒性反应的机制,虽仍然处于研究阶段,但是根据第三届美国区域麻醉与疼痛医学学会(American Society of Regional Anesthesia and Pain Medicine,ASRA)关于局部麻醉系统毒性的实践咨询建议,应在使用LA后出现心律失常、惊厥发作的第一时使用LE治疗。相较于LA循环系统毒性,其中枢神经系统(central nervous system,CNS)毒性出现的更早,中毒阈剂量更低。近年来,LA的CNS毒性研究日益增多,对LE用于LA的CNS急性毒性反应救治的深入研究可能使局部麻醉并发症得到更为有效的预防及治疗。文章对最近几年LA的CNS急性毒性机制和最新防治方法进行综述,可为临床上遇到LA中毒出现CNS毒性症状时及时有效处理和有效解毒药物的开发提供理论依据。

Convulsions and arrhythmias are the most life‐threatening acute complications of local anesthetic(LA)acute systemic toxicity(LAST).The mechanism by which lipid emulsion(LE)prevents and treats LAST is still on the research stage.However,according to the Third American Society of Regional Anesthesia and Pain Medicine(ASRA)practice advisory on local anesthetic systemic toxicity,LE therapy should be adopted at the first time of arrhythmia and seizures after LA are given.Compared with the toxicity of LA in the circulation system,the toxicity in the central nervous system(CNS)occurs earlier,with a lower poisoning threshold dose.In the recent years,the studies concerning the toxicity of LA in CNS are increasing.Further researches about the use of LE to treat and control the acute toxicity of LA in CNS may become more effective to prevent and treat LA complication.This paper reviews the acute toxicity mechanism and the latest prevention and treatment methods of LA in CNS in the recent years,which can provide theoretical evidence for timely treatment and development of effective detoxification drugs when LA poisoning occurs.