胰岛素-葡萄糖-钾（IGK）预处理对布比卡因心脏毒性的影响。

The effects of an insulin-glucose-potassium (IGK) pretreatment on the bupivacaine cardiotoxicity.

机构信息

Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.

出版信息

Korean J Anesthesiol. 2013 Jan;64(1):47-53. doi: 10.4097/kjae.2013.64.1.47. Epub 2013 Jan 21.

DOI:10.4097/kjae.2013.64.1.47

PMID:23372886

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3558649/

Abstract

BACKGROUND

The purpose of this study is to evaluate the effect of an IGK pretreatment on the cardiotoxicity of bupivacaine.

METHODS

Twenty-one anesthetized mongrel dogs were randomly divided into the following three groups: the control group (CG, n = 7), the treatment group (TG, n = 7) and the pretreatment group (PTG, n = 7). For the 30 min of pretreatment period, CG and TG received normal saline, while PTG received an IV bolus of insulin 2 U/kg, followed by an IGK infusion (2 U/kg/hr of insulin, 0.5-1.5 g/kg/hr of glucose, 1-2 mEq/kg/hr of KCl). The bupivacaine infusion was started at the rate of 0.5 mg/kg/min in all groups after the pretreatment period. CG received normal saline only. In TG, insulin (2 U/kg) was injected simultaneously with bupivacaine infusion, followed by the IGK infusion as with PTG. The hemodynamic variables and the time duration to reach the mean arterial pressure (MAP) of 60 mmHg were compared.

RESULTS

The bupivacaine infusion decreased the cardiac index, MAP, and heart rate in all three groups. Although insulin concentration was higher in TG than in PTG during bupivacaine infusion, the hemodynamic variables in PTG decreased at the slowest rate. The time taken to reach MAP of 60 mmHg in PTG, TG, and CG was 51.4 ± 8.5, 36.4 ± 9.6, and 27.1 ± 8.7 min, respectively (P < 0.05).

CONCLUSIONS

IGK delays the bupivacaine-induced cardiac depression. However, a pretreatment with IGK is more effective in delaying the bupivacaine-induced hypotension than simultaneous administration, regardless of insulin concentration.

摘要

背景

本研究旨在评估 IGK 预处理对布比卡因心脏毒性的影响。

方法

将 21 只麻醉杂种犬随机分为三组：对照组（CG，n = 7）、治疗组（TG，n = 7）和预处理组（PTG，n = 7）。在预处理期的 30 分钟内，CG 和 TG 接受生理盐水，而 PTG 接受 IV 推注胰岛素 2 U/kg，随后输注 IGK（胰岛素 2 U/kg/hr，葡萄糖 0.5-1.5 g/kg/hr，钾 1-2 mEq/kg/hr）。预处理期结束后，所有组均以 0.5 mg/kg/min 的速度开始输注布比卡因。CG 仅接受生理盐水。在 TG 中，胰岛素（2 U/kg）与布比卡因输注同时注射，随后与 PTG 一样输注 IGK。比较各组的血流动力学变量和达到平均动脉压（MAP）60 mmHg 的时间。

结果

布比卡因输注降低了三组的心脏指数、MAP 和心率。尽管 TG 中的胰岛素浓度在输注布比卡因期间高于 PTG，但 PTG 的血流动力学变量下降速度最慢。PTG、TG 和 CG 达到 MAP 60 mmHg 的时间分别为 51.4 ± 8.5、36.4 ± 9.6 和 27.1 ± 8.7 分钟（P < 0.05）。