脂肪乳剂联合肾上腺素对布比卡因中毒羊血流动力学的影响

摘要

目的：探讨脂肪乳剂联合肾上腺素对布比卡因中毒羊血流动力学的影响。方法选择健康成年雄性绵羊18只，采用随机数字表法分为联合组、肾上腺素组及对照组，每组6只。应用布比卡因建立心脏毒性模型，其中肾上腺素组给予单次静脉注射25μg肾上腺素治疗，联合组给予30％的脂肪乳剂后静脉注射25μg肾上腺素治疗，对照组给予等体积的生理盐水。比较中毒羊在布比卡因注射前（T0）、中毒造模成功时（T1）、停止输注布比卡因后5 min（T2）、15 min（T3）、30 min（T4）、60 min （T5）时的血流动力学指标[心排血量、平均动脉压（MAP）、心率、中心静脉压（CVP）、平均肺动脉压（ MPAP）]的变化情况，同时记录中毒后 MAP 恢复至布比卡因注射前80％时所需的时间（T80％MAP）。结果联合组心排出量、MAP、心率在 T1下降，T2即大幅度升高，至 T5时基本达到 T0水平，肾上腺素组则在T1下降，从T2开始缓慢上升，至T5时较T0降低，而对照组从T1下降，T2～T5升高较缓慢，T5时较T0降低很多。 CVP在联合组T1上升，T2开始下降，并一直持续下降至T5，较接近T0水平，肾上腺素组 T1升高，T2逐渐下降，至 T5下降较联合组慢，对照组 T1～T2升高，T3～T5下降，联合组、肾上腺素组和对照组心排出量、MAP、心率、CVP在组间、时间点、组间・时间点交互作用差异均有统计学意义（均P＜0.05）。 MPAP在组间、时点间、组间・时点间交互作用差异均无统计学意义（均 P ＞0.05）。联合组、肾上腺素组及对照组的 T80％MAP分别为（19.5±3.4） min、（32.8±6.5） min和（41.9±6.3） min，联合组 T80％MAP的时间短于肾上腺素组和对照组（ t ＝4.441， P＝0.000；t＝7.642，P＝0.000），而肾上腺素组又短于对照组（t＝3.158，P＝0.000）。结论与单一肾上腺素相比，脂肪乳剂联合肾上腺素能更好地改善布比卡因中毒羊的血流动力学，缩短心功能恢复时间，缓解心脏中毒症状。%Objective To investigate the effect of fat emulsion and epinephrine on hemodynamics of bupivacaine intoxicated sheep.Methods Eighteen healthy adult male sheep were selected and divided into combination group,epinephrine group and control group by random number table method,six sheep in each group.Cardiotoxicity models were established by bupivacaine.The epinephrine group was treated by 25 μg epinephrine once,the combination group was treated by 30% fat emulsion combined with 25 μg epinephrine, the control group was given same capacity physiological saline.The hemodynamics indexes which included cardiac output,mean arterial pressure(MAP),heart rate,central venous pressure(CVP),mean pulmonary arterial pressure(MPAP) were compared among the three groups at the same points of before injection of bupivacaine (T0),after successful modeling (T1),5 min after stopping injection of bupivacaine (T2), 15 min after stopping injection of bupivacaine ( T3 ) ,30 min after stopping injection of bupivacaine ( T4 ) , 60 min after stopping injection of bupivacaine ( T5 ) .And the time of MAP returning to 80% of before bupiv-acaine injection after intoxication ( T80%MAP ) was recorded.Results Cardiac output,MAP and heart rate of the combination group at T1 decreased,but increased significantly from T2 ,reaching T0 level at T5 ,of the epi-nephrine group at T1 decreased,but increased gradually from T2 ,lower than T0 at T5 ,of the control group at T1 decreased,but increased slowly from T2-T5 ,but T5 was much lower than T0 CVP of the combination group at T1 increased significantly,at T2 ,T3 ,T4 ,T5 gradually decreased till T0 level,of the epinephrine group at T1 increased,but gradually decreased since T2,slowe than the combination group,of the control group increased during T1-T2 ,decreasded during T3-T5 .The cardiac output, MAP,heart rate,CVP among the three groups, at different time points,different groups and groups・ different time points had statistically significant differ-ence(P<0.05);MPAP at different time points,different groups and groups・ different time points had no statistically significant difference(P>0.05).The T80%MAP of combination group,epinephrine group and con-trol group were (19.5 ±3.4) minutes,(32.8 ±6.5)minutes and(41.9 ±6.3)minutes respectively,combi-nation group was shorter than that of epinephrine group and control group (t=4.441,P=0.000,t=7.642, P=0.000),and epinephrine group was shorter than control group(t =3.158,P =0.000).Conclusion Compared with single epinephrine,fat emulsion and epinephrine can better improve the hemodynamics inde-xes of bupivacaine intoxicated sheep,shorten myocardial function recovery time,and release the heart poison-ing symptoms.