脂肪乳剂复苏布比卡因导致的心脏停搏的机制探讨【精品论文】.doc

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1、脂肪乳剂复苏布比卡因导致的心脏停搏的机制探讨作者：小小小作者：施通，刘乐，施克俭，王权光，陈莺，王方岩，徐旭仲【摘要】FI的？：探讨脂肪乳剂逆转布比卡因心脏毒性可能的作用机制。方法：SD雄性大鼠72只，随机分成六组：A组(布比卡因致心脏停搏脂肪乳剂复苏组)、B组(布比卡因致心脏停搏K-H液灌注组)、C组(布比卡因致心脏停搏组)、D组(平衡灌注25min组)、E纽(含脂肪乳剂的K-H液灌注组)、F组(K-H液灌注组)，每纽12只。记录灌注期间的心率-左心室发展压乘积(RPP),测定停灌吋各组心肌组织

2、腺昔酸含量和布比卡因浓度。结果：A组复跳例数、早期复跳例数均显著多于B组(P?<0.01)oA组复跳时间显著短于B组(P?<0.05)o复跳后40mi门内，A组的RPP均显著高于B组(P?<0.01)oA组的EC值显著低于B组(P?<0.05)。心肌组织屮的彳

3、j比卡因浓度从高到低依次为C组〉B组〉A组(P?<0.01)o结论：脂肪乳剂降低心肌组织布比卡因浓度，是其逆转布比卡因心脏毒性的主要作用机制。【关键词】脂肪乳剂;布比卡因;心脏复苏;心脏停博，人工;大鼠Abstract:?Objective

4、:Toexploreanddiscussthepossiblemechanismoflipidemulsiontorescuethebupivacaine-inducedcardiacarrest.Methods:?TheheartsofmaleSprague~DawleyratswereexcisedandretrogradelyperfusedinannonrecirculatingLangendorffpreparation.Theywererandomlydividedintosixgro

5、ups(twelveheartspereachgroup).IngroupA,BandC,afterKrebs-Henseleitbuffer?(KHB)?wasperfusedfor25min,100nmol/Lbupivacainewasperfuseduntil3minafterasystole.Then2%lipidemulsionand30umol/LbupivacainemixturewasperfusedingroupA;30Pmol/Lbupivacainewasperfusedi

6、ngroupB;perfusionwasstopedatthattimeingroupC.IngroupD,EandF,KHBwasperfusedfor25min.Then2%lipidemulsionwasperfusedfor40miningroupE?;KHBwasperfusedfor40miningroupF?;perfusionwasstopedatthattimeingroupD.?Thetimefromtheendoftheperfusionwith100umol/Lbupiva

7、cainetotheheartresuscitation?(Tr)?werecomparedbetweengroupAandB.Thecasesofrecovery(heartbeatingrecoveredaftertheendofthe100umol/Lbupivacaineperfusion)andthecasesofearlyrecovery(heartbeatingrecoveredwithin3minaftertheendofthe100Pmol/Lbupivacaineperfusi

8、on)wererecorded.Rate-pressureproduct(RPP二heartrateX[leftventricularsystolicpressure-1eftventriculardiastolicpressure])duringthecourseofresuscitationingroupAandBweremonitored.RPPduringthecourseofperfusioningroupEandFweremonitored.Attheendofeachprotocol

9、,?myocardialtissuesweretakenfromtheapexoftheleftventricleformeasuringATP,ADP,AMP,totaiadeninenucleotides(TAN)andenergycharge(EC).?TheconcentrationsofbupivacaineinmyocardialtissuesamonggroupA,B,Cwerealsomeasured.Results:?Therecoverycasesandthec