利多卡因及伊布利特在治疗犬长时间心室颤动模型中的疗效比较

摘要

Objective :To compare the efficacy of lidocaine and ibutilide respectively combined with adrenaline in treating the ventricularfibrillation(VF) in Canine Model.Methods :The experimental dog had 12 minutes of untreated VF, and then received 2 min of cardiopulmonary resuscitation (CPR) followed by immediate defibrillation of 100J biphase. Dogs with persistent VF were randomly assigned into 3 groups,n=8 in each group. Lidocaine( 1.5 mg/kg) +adrenaline(0. 02 mg/kg) group, Ibutilide(0. 01 mg/kg) +adrenaline group,and adrenaline alone(Control) group. If VF still continued,then CPR was continued, defibrillation energy was increased to 150J biphnse, and the same medications were used every 5 min. The endpoint was return of spontaneous circulation. During the entire experiment, the aortic and right atrial pressures were continuously monitored, coronary perfusion pressure (CPP) was examined and the corrected QT interval (QTc) was calculated by Bazett's formula.Results:The QTc in Lidocaine+adrenaline group and Control group were obviously lower than that in Ibutilide+adrenaline group,P＜0. 05 respectively. The CPP in Lidocaine+adrenaline group and Ibutilide+adrenaline group were higher than that in Control group,P＜0. 05 respectively. The defibrillation energy in Lidocaine+adrenaline group and Ibutilide+adrenaline group were lower than that in Control group,P＜0. 05 respectively.Conclusion: Lidocaine and ibutilide respectively combined with adrenaline are both effective for improving the CPP in treating VF in canine model.%目的:利多卡因和伊布利特分别联用肾上腺素,应用到心室颤动的早期治疗过程中,比较两种药物的疗效.方法:犬心室颤动12分钟后立即进行2分钟的胸外按压,随即100 J双向波电除颤,仍为心室颤动的犬随机分为3组(每组8只),分别给予相应药物:利多卡因组,利多卡因(1.5 mg/kg)联用肾上腺素(0.02 mg/kg);伊布利特组:伊布利特(0.01 mg/kg)联用肾上腺素(0.02 mg/kg);对照组:只应用肾上腺素(0.02 mg/kg).用药时胸外按压不间断,每2分钟的胸外按压后进行1次电除颤,如心室颤动持续存在,上述剂量的药物每5分钟重复用1次,终点事件为自主循环恢复.实验过程中监测与记录主动脉、右心房压力,计算冠状动脉灌注压,测量基础状态和复苏后的QT间期,计算出校正的QT间期(QTc).结果:利多卡因组及对照组动物的QTc明显低于伊布利特组,差异有统计学意义(P＜0.05).利多卡因组及伊布利特组动物的主动脉平均压、冠状动脉灌注压均高于对照组,差异有统计学意义(P＜0.05),且利多卡因组及伊布利特组动物的除颤能量低于对照组,差异有统计学意义(P＜0.05).结论:对心室颤动犬进行心肺复苏时,联用利多卡因或伊布利特与肾上腺素同样有效的提高了冠状动脉灌注压.