在使用阿托品、钙剂和生理盐水复苏的严重维拉帕米中毒动物模型中静脉注射脂肪乳剂的血流动力学效应。
Hemodynamic effects of intravenous fat emulsion in an animal model of severe verapamil toxicity resuscitated with atropine, calcium, and saline.
作者信息
Bania Theodore C, Chu Jason, Perez Eric, Su Mark, Hahn In-Hei
机构信息
Department of Clinical Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University, New York, NY, USA.
出版信息
Acad Emerg Med. 2007 Feb;14(2):105-11. doi: 10.1197/j.aem.2006.10.094.
BACKGROUND
Intravenous fat emulsion (IFE) decreases cardiotoxicity from several lipid-soluble drugs, including verapamil.
OBJECTIVES
To verify if the addition of IFE to the standard treatment of severe verapamil toxicity would improve hemodynamics and survival.
METHODS
Fourteen dogs were instrumented to measure systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), heart rate, cardiac output, central venous pressures, left ventricular pressure changes over time, mixed venous oxygen saturation, pH, and base excess. Verapamil toxicity, defined as a 50% decrease in MAP, was induced with verapamil at 6 mg/kg/hr and maintained for 30 minutes by titrating the verapamil infusion rate. Following verapamil toxicity, the verapamil infusion rate was changed to 2 mg/kg/hr and continued for 90 minutes. All dogs were resuscitated with atropine (0.04 mg/kg intravenously) and calcium chloride (15 mg/kg intravenously every 5 minutes for three doses) and then randomized to receive either IFE (7 mg/kg of 20%) intravenously or equivalent volumes of 0.9% normal saline over 30 minutes. Measurements were recorded for 120 minutes by investigators blinded to the treatment. Data were analyzed using analysis of variance, survival analysis, and log-rank test.
RESULTS
Before the 30-minute IFE or normal saline infusion, there were no differences in hemodynamic parameters. After IFE or normal saline infusion, the IFE-treated group had higher MAP at 30 minutes (95% confidence interval [CI] = 5.6 to 44.7 mm Hg), 45 minutes (95% CI = 10.8 to 50.0 mm Hg), and 60 minutes (95% CI = 10.2 to 53.1 mm Hg). Kaplan-Meier 120-minute survival rate was 14% (95% CI = 0.5% to 53%) for the saline group as compared with 100% (95% CI = 59% to 100%) for the IFE group (p = 0.01).
CONCLUSIONS
Standard resuscitation and IFE increase MAP and survival in an animal model of severe verapamil toxicity compared with standard resuscitation alone.
背景
静脉脂肪乳剂（IFE）可降低包括维拉帕米在内的几种脂溶性药物的心脏毒性。
目的
验证在严重维拉帕米中毒的标准治疗中添加IFE是否能改善血流动力学和提高生存率。
方法
对14只犬进行仪器安装以测量收缩压、舒张压、平均动脉压（MAP）、心率、心输出量、中心静脉压、左心室压力随时间的变化、混合静脉血氧饱和度、pH值和碱剩余。以6mg/kg/hr的速度静脉注射维拉帕米诱导维拉帕米中毒，定义为MAP下降50%，通过调整维拉帕米输注速率维持30分钟。维拉帕米中毒后，将维拉帕米输注速率改为2mg/kg/hr并持续90分钟。所有犬均用阿托品（0.04mg/kg静脉注射）和氯化钙（每5分钟静脉注射15mg/kg，共注射三剂）进行复苏，然后随机分为在30分钟内静脉注射IFE（7mg/kg的20%）或等量的0.9%生理盐水。由对治疗不知情的研究人员记录120分钟的测量数据。使用方差分析、生存分析和对数秩检验对数据进行分析。
结果
在30分钟的IFE或生理盐水输注前，血流动力学参数无差异。在IFE或生理盐水输注后，IFE治疗组在30分钟（95%置信区间[CI]=5.6至44.7mmHg）、45分钟（95%CI=10.8至50.0mmHg）和60分钟（95%CI=10.2至53.1mmHg）时的MAP更高。生理盐水组的Kaplan-Meier 120分钟生存率为14%（95%CI=0.5%至53%），而IFE组为100%（95%CI=59%至100%）（p=0.01）。
结论
与单纯标准复苏相比，标准复苏和IFE可提高严重维拉帕米中毒动物模型的MAP和生存率。
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