Aya A G M, Ripart J, Sebbane M-A, de La Coussaye J-E
Département d'anesthésie-douleur, pôle anesthésie-réanimation-douleur-urgences, GHU de Caremeau, Nîmes, France.
Ann Fr Anesth Reanim. 2010 Jun;29(6):464-9. doi: 10.1016/j.annfar.2010.03.020. Epub 2010 May 26.
Local anaesthetic toxicity always results from rapid and important increase in their plasma concentrations. Clinically, neurologic and cardiovascular symptoms may occur, especially life-threatening cardiac arrhythmias and cardiac depression. Resuscitating patients from cardiac toxicity was known as difficult, until the introduction of lipid emulsion therapy. From experimental data, at least two mechanisms of action can be proposed, a sink-effect and an improvement of cardiomyocyte metabolism. The present article is a mini-review of the current use of lipid emulsions for the treatment of local anaesthetic cardiac toxicity. The mechanisms of cardiac toxicity and those of lipid emulsion therapy are summarized, and the clinical experience of this therapy and its limits are presented.
局部麻醉药毒性总是由其血浆浓度迅速且显著升高所致。临床上，可能会出现神经和心血管症状，尤其是危及生命的心律失常和心脏抑制。在脂质乳剂疗法引入之前，使心脏毒性患者复苏被认为很困难。从实验数据来看，至少可以提出两种作用机制，即“汇效应”和心肌细胞代谢改善。本文是一篇关于脂质乳剂目前用于治疗局部麻醉药心脏毒性的小型综述。总结了心脏毒性机制和脂质乳剂疗法机制，并介绍了该疗法的临床经验及其局限性。
