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Bupivacaine cardiotoxicity and subendocardial microcirculation

布比卡因心脏毒性和心内膜下微循环

基本信息

批准号：
07457364
负责人：
FUJITA Yoshihisa
金额：
$ 3.97万
依托单位：
KAWASAKI MEDICAL SCHOOL
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (B)
财政年份：
1995
资助国家：
日本
起止时间：
1995 至 1996
项目状态：
已结题

项目摘要

Ventricular fibrillation (VF) and depression of myocardial contractility are two important factors for bupivacaine-induced cardiotoxicity. The efficacy of lidocaine for bupivacaine-induced VF and the vasoconstricting effects of bupivacaine were examined in the beating hearts in vivo. In the first set of the experiment, 0.25% bupivacaine, 1% lidocaine and 0.25% bupivacaine plus lidocaine solutions were infused into the left anterior descending coronary artery (LAD) in an increasing sequence of 0,1,2,4,8 and 16 mL/hr for 15 min into the LAD in three groups consisting of eight pigs. Regional myocardial function was evaluated by the sonomicrometry technique. While there were no VF in the Lid group, VF occurred in one at 4 mL/hr and seven at 8 mL/hr infusion rates in the bupivacaine group, and in one at 8 mL/hr and seven at 16 mL/hr infusion rates in the bupivacaine plus lidocaine group. Although regional myocardial function decreased in a dose-related manner in the three groups, the myocardial depressant effects of bupivacaine were significantly greater than that of lidocaine, and did not differ with that of bupivacaine plus lidocaine. In the second set of the experiment, six samples of bupivacaine-containing autologous blood (0,0.25,1.25,2.5,5,10mug/mL) were injected into the coronary artery via a catheter placed in the first diagonal branch in the five pigs, while left ventricular subendocardial microvessels (50-100mum in diameter) in the septal region were visualized by a needle type video microscope. Diameter of the

心室颤动（VF）和心肌收缩力抑制是布比卡因引起的心脏毒性的两个重要因素。在体内跳动的心脏中检查了利多卡因对布比卡因诱导的心室颤动的功效和布比卡因的血管收缩作用。在第一组实验中，将 0.25% 布比卡因、1% 利多卡因和 0.25% 布比卡因加利多卡因溶液按 0、1、2、4、8 和 16 mL/hr 的递增顺序注入左冠状动脉前降支 (LAD)，持续 15 分钟，分三组，每组 8 头猪。通过声测法技术评估局部心肌功能。虽然 Lid 组没有发生心室颤动，但布比卡因组中，在 4 mL/hr 输注速度下，发生 1 例心室颤动，在 8 mL/hr 输注速度下，有 7 例发生心室颤动；在布比卡因加利多卡因组，在 8 mL/hr 输注速度下，发生 1 例心室颤动，在 16 mL/hr 输注速度下，发生 7 例心室颤动。虽然三组局部心肌功能均呈剂量相关下降，但布比卡因的心肌抑制作用明显大于利多卡因，且与布比卡因联合利多卡因没有差异。第二组实验中，将六份含布比卡因的自体血（0、0.25、1.25、2.5、5、10mug/mL）通过放置在五只猪第一对角分支的导管注入冠状动脉，同时通过针型观察间隔区左心室心内膜下微血管（直径50-100μm）视频显微镜。直径