在猪模型中，高渗碳酸氢钠对维拉帕米中毒的急性处理有效。

Hypertonic sodium bicarbonate is effective in the acute management of verapamil toxicity in a swine model.

作者信息

Tanen D A, Ruha A M, Curry S C, Graeme K A, Reagan C G

机构信息

Department of Medical Toxicology, Good Samaritan Regional Medical Center, the University of Arizona College of Medicine, Phoenix, AZ, USA.

出版信息

Ann Emerg Med. 2000 Dec;36(6):547-53. doi: 10.1067/mem.2000.109509.

DOI:10.1067/mem.2000.109509

PMID:11097693

Abstract

STUDY OBJECTIVE

This study was conducted to determine whether hypertonic sodium bicarbonate would improve the hypotension associated with severe verapamil toxicity compared with volume expansion.

METHODS

The study design used a nonblinded acute animal preparation. Twenty-four anesthetized and instrumented swine were poisoned with verapamil delivered at a rate of 1 mg/kg per hour for 10 minutes followed by incremental increases of 1 mg/kg per hour every 10 minutes until the endpoint of a mean arterial blood pressure of 45% of baseline was achieved. Animals alternately received either 4 mEq/kg of hypertonic sodium bicarbonate intravenously over 4 minutes or similar volumes of 0.6% sodium chloride in 10% mannitol (control). The main outcome parameter followed was mean arterial pressure. In addition, physiologic parameters including cardiac output, heart rate, pH, PCO (2), PO (2), plasma ionized calcium, sodium, and potassium were monitored.

RESULTS

Verapamil toxicity, as defined by a mean arterial pressure of 45% of baseline, was produced in all animals following an average verapamil infusion dose of 0.6+/-0.12 mg/kg. This dose produced an average plasma verapamil concentration of 728.1+/-155.4 microgram/L, with no significant difference between groups. Swine treated with hypertonic sodium bicarbonate experienced a significant increase in mean arterial pressure (>50%) and cardiac output (>30%) over the first 20 minutes that slowly equilibrated with the control group over the remainder of the experiment. As expected, plasma sodium concentrations were elevated significantly in the sodium bicarbonate group while plasma potassium concentrations were decreased significantly. Finally, there was a significant decrease in plasma ionized calcium concentration in the sodium bicarbonate-treated group compared with controls.

CONCLUSION

Hypertonic sodium bicarbonate reversed the hypotension and cardiac output depression of severe verapamil toxicity in a swine model.

摘要

研究目的

本研究旨在确定与扩容相比，高渗碳酸氢钠是否能改善与严重维拉帕米中毒相关的低血压。

方法

本研究设计采用非盲法急性动物实验。24只麻醉并安装监测仪器的猪以每小时1mg/kg的速率静脉输注维拉帕米10分钟，随后每10分钟递增1mg/kg，直至平均动脉血压达到基线值的45%这一终点。动物交替接受在4分钟内静脉注射4mEq/kg高渗碳酸氢钠或等量的0.6%氯化钠加10%甘露醇（对照组）。主要观察指标为平均动脉压。此外，还监测了包括心输出量、心率、pH值、二氧化碳分压、氧分压、血浆离子钙、钠和钾等生理参数。

结果

所有动物在平均输注维拉帕米剂量为0.6±0.12mg/kg后，均出现了定义为平均动脉血压为基线值45%的维拉帕米中毒。该剂量产生的平均血浆维拉帕米浓度为728.1±155.4μg/L，两组间无显著差异。接受高渗碳酸氢钠治疗的猪在最初20分钟内平均动脉压显著升高（>50%），心输出量显著增加（>30%），在实验剩余时间内与对照组缓慢趋于平衡。正如预期的那样，碳酸氢钠组血浆钠浓度显著升高，而血浆钾浓度显著降低。最后，与对照组相比，碳酸氢钠治疗组血浆离子钙浓度显著降低。