Comparison of the Effects of Racemic Bupivacaine, Levobupivacaine, and Ropivacaine on Ventricular Conduction, Refractoriness, and Wavelength: An Epicardial Mapping Study
Comparison of the Effects of Racemic Bupivacaine, Levobupivacaine, and Ropivacaine on Ventricular Conduction, Refractoriness, and Wavelength: An Epicardial Mapping Study
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外消旋布比卡因、左布比卡因和罗哌卡因对心室传导、不应性和波长的影响比较：心外膜标测研究
DOI：
10.1097/00000542-200203000-00021
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发表时间：
2002
期刊：
影响因子：
8.8
通讯作者：
J. Eledjam
中科院分区：
文献类型：
--
作者：
A. Aya;J. E. de La Coussaye;E. Robert;J. Ripart;P. Cuvillon;J. Mazoit;P. Jeannes;P. Fabbro‐Peray;J. Eledjam
背景本研究旨在比较等摩尔浓度的外消旋布比卡因、左布比卡因和罗哌卡因对心室传导、各向异性、不应期的持续时间和均匀性以及波长的影响，并提供对传导速度影响的效力比。方法 用 0.1、1 和 10 µm 外消旋布比卡因、左布比卡因或罗哌卡因处理离体冷冻兔心脏（留下一层薄薄的幸存心外膜肌肉）。研究了左心室纵向和横向传导速度、各向异性比、最小起搏周期长度、使用依赖性、心室有效不应期的持续时间和离散度以及波长。高分辨率测绘系统用于数据采集。除了重复测量的双向方差分析之外，还使用非线性混合效应建模程序同时拟合传导速度数据，以进行组间比较。结果 每种药剂都会引起浓度和使用依赖性的传导速度减慢，而各向异性比率没有变化。左布比卡因在纵向传导速度方面的使用依赖效应与外消旋布比卡因相似。传导速度的拟合提供了外消旋布比卡因与左布比卡因和罗哌卡因的比例，对于 1,000 毫秒起搏周期长度的浓度效应，为 1:1.38；对于 600 毫秒起搏周期长度的依赖效应，外消旋布比卡因与左布比卡因和罗哌卡因的比例为 1:0.74。外消旋布比卡因和左布比卡因延长心室有效不应期，而罗哌卡因则不然。心室有效不应期值没有出现偏差。所有三种试剂均引起波长显着减小。这种效应在各组之间没有差异。结论 等摩尔浓度外消旋布比卡因、左布比卡因和罗哌卡因之间的差异主要是由对传导速度的使用依赖性影响和对心室有效不应期的浓度依赖性影响引起的。因此，在比较局麻药的效力比时，必须考虑相应的起搏速率。
Background The study was designed to compare the effects of equimolar concentrations of racemic bupivacaine, levobupivacaine, and ropivacaine on ventricular conduction, anisotropy, duration and homogeneity of refractoriness, and wavelengths, and to provide a potency ratio for effects on conduction velocity. Methods Isolated frozen rabbit hearts (which leave a thin layer of surviving epicardial muscle) were treated with 0.1, 1, and 10 &mgr;m racemic bupivacaine, levobupivacaine, or ropivacaine. Left ventricular longitudinal and transverse conduction velocities, anisotropic ratio, minimum pacing cycle length, use dependency, duration and dispersion of ventricular effective refractory period, and wavelengths were studied. A high-resolution mapping system was used for data acquisition. In addition to two-way analysis of variance for repeated measures, data for conduction velocities were fitted simultaneously using a nonlinear mixed-effect modeling program to allow intergroup comparison. Results Each agent induced a concentration- and use-dependent slowing of conduction velocities, with no change of the anisotropic ratio. The use-dependent effect of levobupivacaine is similar to that of racemic bupivacaine concerning longitudinal conduction velocity. Fitting of conduction velocities provided a racemic bupivacaine to levobupivacaine and to ropivacaine ratio of 1:1.38 for concentration effect at 1,000-ms pacing cycle length, and 1:0.74 for use-dependent effect at 600-ms pacing cycle length. Racemic bupivacaine and levobupivacaine prolonged the ventricular effective refractory period, whereas ropivacaine did not. No dispersion in ventricular effective refractory period values occurred. All three agents induced significant decreases in wavelengths. This effect was not different among groups. Conclusions Differences among racemic bupivacaine, levobupivacaine, and ropivacaine at equimolar concentrations are mainly caused by the use-dependent effects on conduction velocities and the concentration-dependent effects on ventricular effective refractory period. Therefore, one must take into account the corresponding pacing rates when comparing the potency ratios of local anesthetics.
影响因子：
20.1
作者：
LIU, DW;GINTANT, GA;ANTZELEVITCH, C
通讯作者：
ANTZELEVITCH, C
影响因子：
3.8
作者：
Baynham,TC;Knisley,SB
通讯作者：
Knisley,SB