中国局部麻醉药全身毒性的区域麻醉与脂质复苏：中华医学会麻醉学分会骨科麻醉学组的调查结果

Regional anesthesia and lipid resuscitation for local anesthetic systemic toxicity in China: results of a survey by the orthopedic anesthesia group of the Chinese Society Of Anesthesiology.

作者信息

Xu Mao, Jin Shanliang, Li Zhengqian, Xu Xuzhong, Wang Xiuli, Zhang Lan, Feng Zeguo, Yu Buwei, Liu Jin, Guo Xiangyang

机构信息

Department of Anesthesiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing, 100191, China.

Department of Anesthesiology, No 3 People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.

出版信息

BMC Anesthesiol. 2016 Jan 4;16:1. doi: 10.1186/s12871-015-0163-0.

DOI:10.1186/s12871-015-0163-0

PMID:26728368

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4700758/

Abstract

BACKGROUND

Intravenous lipid emulsions have been introduced for the management of patients with Local Anesthetic Systemic Toxicity (LAST). These emulsions have been stated as a first-line treatment in the guidelines of several international anesthesia organizations. Nevertheless, the adoption of lipid rescue therapy by Chinese practitioners remains unknown. We, therefore, evaluated the current approaches to treat LAST and the use of lipid rescue therapy among anesthesiologists in China.

METHODS

In September 2013, a 23-question survey on regional anesthesia practice and availability of lipid emulsions was sent by e-mail to directors or designated individuals at 41 academic anesthesiology departments listed by the orthopedic anesthesia group of the Chinese Society of Anesthesiology.

RESULTS

Responses were received from 36 of the 41 (88 %) anesthesiology departments. To simplify the analysis, responses were divided into two groups according to the annual percentage of patients who received regional anesthesia (RA) for orthopedic anesthesia: 14 departments (39%) with high-utilization (≥ 50%) and 22 departments (61%) low-utilization (<50%) of RA. Ropivacaine and bupivacaine were the common drugs used for RA, which were independent of RA utilization. Interestingly, ultrasound-guided techniques were much more frequently used in low-utilization institutions than in high-utilization institutions (P = 0.025). Lipid emulsion was readily available in 8 of the 36 (22%) responding institutions, with 7 of the other 28 (25%) institutions planning to stock lipid emulsion. No differences in lipid availability and storage plans were observed between high- and low-utilization institutions. Lipid resuscitation was performed in five of the eight departments that had lipid emulsion. Eleven patients were successfully resuscitated and one was not.

CONCLUSION

Lipid emulsion is not widely available in China to treat LAST resulted from RA for orthopedic patients. Efforts are required to promote lipid rescue therapy nationwide.

TRIAL REGISTRATION

Chinese Clinical Trail Registry (Registration number # ChiCTR-EOR-15006960; Date of Retrospective Registration on August 23rd, 2015) http://www.chictr.org.cn/showproj.aspx?proj=11703 .

摘要

背景

静脉注射脂质乳剂已被用于局部麻醉药全身毒性（LAST）患者的治疗。这些乳剂在多个国际麻醉组织的指南中被列为一线治疗药物。然而，中国从业者对脂质救援疗法的采用情况尚不清楚。因此，我们评估了中国麻醉医生目前治疗LAST的方法以及脂质救援疗法的使用情况。

方法

2013年9月，通过电子邮件向中国麻醉学会骨科麻醉组列出的41个学术麻醉科的主任或指定人员发送了一份关于区域麻醉实践和脂质乳剂可用性的23个问题的调查问卷。

结果

41个麻醉科中有36个（88%）回复了问卷。为了简化分析，根据接受骨科麻醉区域麻醉（RA）的患者年度百分比将回复分为两组：14个科室（39%）高使用率（≥50%）和22个科室（61%）低使用率（<50%）的RA。罗哌卡因和布比卡因是用于RA的常用药物，这与RA使用率无关。有趣的是，超声引导技术在低使用率机构中比在高使用率机构中使用得更为频繁（P = 0.025）。36个回复机构中有8个（22%）有脂质乳剂，另外28个机构中有7个（25%）计划储备脂质乳剂。高使用率和低使用率机构之间在脂质可用性和储存计划方面没有差异。有脂质乳剂的8个科室中有5个进行了脂质复苏治疗（。11名患者成功复苏，1名未成功。