de La Coussaye J E, Brugada J, Allessie M A
Department of Anesthesiology, University Hospital of Nîmes, France.
Anesthesiology. 1992 Jul;77(1):132-41.
It has been shown that administration of toxic doses of bupivacaine may induce ventricular dysrhythmias. However, the mechanism of these dysrhythmias is still unknown. The present study was designed to test the hypothesis that bupivacaine facilitates the occurrence of reentrant ventricular dysrhythmias. High-resolution ventricular epicardial mapping was used to study the effects of 0.2, 0.5, 1.0, and 5.0 micrograms/ml bupivacaine in 11 Langendorff-perfused rabbit hearts. Five hearts were kept intact (intact heart). In six other hearts, a thin layer of epicardium was obtained by an endocardial cryotechnique (frozen heart). Bupivacaine induced ventricular dysrhythmias in 3 of 5 intact hearts at 5.0 micrograms/ml. In 3 of 6 frozen hearts, 0.2 micrograms/ml bupivacaine facilitated the induction of ventricular tachycardia by programmed electrical stimulation. Epicardial mapping showed that all tachycardias were based on reentry of the impulse around an arc of functional conduction block. Moreover, bupivacaine significantly prolonged the ventricular effective refractory period and slowed longitudinal and transverse conduction velocity in a dose- and use-dependent manner. It is concluded that bupivacaine facilitates induction of reentrant ventricular dysrhythmias in isolated rabbit heart.
已表明给予毒性剂量的布比卡因可能诱发室性心律失常。然而，这些心律失常的机制仍不清楚。本研究旨在检验布比卡因促进折返性室性心律失常发生这一假说。采用高分辨率心外膜标测技术研究了0.2、0.5、1.0和5.0微克/毫升布比卡因对11个Langendorff灌注兔心脏的影响。5个心脏保持完整（完整心脏）。另外6个心脏通过心内膜冷冻技术获得一薄层心外膜（冷冻心脏）。5.0微克/毫升布比卡因在5个完整心脏中的3个诱发了室性心律失常。在6个冷冻心脏中的3个，0.2微克/毫升布比卡因通过程序性电刺激促进了室性心动过速的诱发。心外膜标测显示所有心动过速均基于冲动围绕功能性传导阻滞弧的折返。此外，布比卡因以剂量和使用依赖的方式显著延长了心室有效不应期并减慢了纵向和横向传导速度。结论是布比卡因促进离体兔心脏折返性室性心律失常的诱发。
