【作者】 徐彬；

【导师】 胡春华；

【作者基本信息】 南昌大学 ， 麻醉学， 2008， 硕士

【摘要】 目的:探讨脂肪乳剂逆转布比卡因心脏毒性的效果。方法:选择健康成年杂种犬18只,行戊巴比妥钠肌注麻醉、气管插管、机械通气、经股动脉直接测压、经股静脉置入漂浮导管后,以速度0.5mg/kg/min经静脉内输注盐酸布比卡因至实验犬平均动脉压下降为40mmHg建立布比卡因心脏毒性模型,均分为A组(n=9)和B组(n=9)。A组毒性模型一次性静脉推注4ml/kg 20%脂肪乳剂,然后以0.5ml/kg/h速度输注20%脂肪乳剂10分钟进行复苏。B组毒性模型一次性给予4ml/kg生理盐水后,然后以速度0.5ml/kg/h输注生理盐水10分钟。持续监测平均动脉压(MAP)、心率(HR)和心电图(ECG),利用漂浮导管于测量各相应时间点心输出量(CO)、中心静脉压(CVP)、肺毛细血管楔压(PCWP)并抽取各相应时间点动静脉血进行血气分析、电解质检测及测量布比卡因血药浓度。结果: (1)A、B两组实验犬体重、血流动力学指标基础值、建立布比卡因心脏毒性模型时各项血流动力学指标数值无统计学差异(P>0.05)。(2)A组实验犬9只全部复苏成功,B组实验犬相继在复苏后10.0±1.8min内死亡(A、B两组之间组间比较p<0.0001)。(3)在复苏后10min, A组实验犬各项血流动力学(HR、CO、MAP、CVP、PAWP)出现不同程度的恢复(p<0.01),B组实验犬血流动力学(HR、CO、MAP、CVP、PAWP)持续恶化(P<0.01)。(4)A组实验犬在复苏后60min时各项血流动力学指标数值与其血流动力学指标基础值无统计学差异(P>0.05)。.结论:脂肪乳剂对布比卡因造成的心脏毒性有较好的逆转作用,可逆转并恢复布比卡因中毒造成的血流动力学影响。更多还原

【Abstract】 Subjective: To study the effect of lipid emulsion on bupivacaine-induced cardiovascular toxicity in dogs.Methods: Eighteen mongrel dogs were anaesthesiaed by pentobarbital sodium via intramuscular, trachea cannula and mechanical ventilation were done in dogs.After directly measuring blood pressure through arteria femoralis and placing Swan-Ganz catheter via vena femoralis, bupivacaine was administered at 0.5mg/kg/min until mean arterial blood pressure decreased to 40 mmHg in order to raise the cardiovascular toxicity model of bupivacaine. Then, these dogs were divided equally into A group(n=9) and B group(n=9). .In the A group(n=9), an IV bolus of regular lipid emulsion(4ml/kg) was given, followed by continuous lipid emulsion infusion (0.5 ml/kg/min of 20% lipid emulsion) for 10 min. In the B group (n=9), an IV bolus of 4ml/kg saline was given ,followed by continuous saline infusion(0.5ml/kg/min of saline) for 10min. MAP,ECG and HR were monitored continuously. CO,CVP and PWCP were measured by Swan-Ganz catheter at every defined time point. Blood gas analysis was done at every defined time point by drawing arterial blood.Drawing venous blood measured blood drug level of bupivacaine and electrolyte at every defined time point.Results: (1)There was no statistic difference on basic conditions dogs, elementary value of haemodynamics and value of haemodynamics of toxicity model dogs between A and B(p>0.05 between A and B) .(2)In the A group, all dogs were resuscitated successly..In the B group, all dogs were died (p<0.0001 between A and B).(3) In the A group, the haemodynamics reverted to the extent at 10min after resuscitation(p<0.01). In the B group, the haemodynamics deteriorated continuously at 10min after resuscitation(p<0.01).(4)In the A group, There was no statistic difference between the value of elementary haemodynamics and the value of haemodynamics at 60min after resuscitation (p>0.05).Conclusions: Lipid emulsion has a good effect on reversing bupivacaine-induced cardiovascular toxicity and can recover the influence of .haemodynamics by bupivacaine intoxation.更多还原