宾赛克嗪对胆碱酯酶抑制剂中毒所致呼吸衰竭和循环衰竭时混合型酸中毒的影响

目的研究胆碱酯酶抑制剂（ChEI）梭曼中毒导致犬发生进行性循环衰竭时酸中毒生化参数指标的变化及新型抗毒剂宾赛克嗪的干预作用。方法 14只杂种犬,雄性,体质量12～15 kg。随机分为循环衰竭组和呼吸衰竭组,每组7只。动物称重、麻醉后,进行气管插管,给予人工正压呼吸。将导管置入左心室、股动脉及股静脉,通过八导电生理记录仪,连续记录心功能及动脉压变化。开始梭曼累积染毒,方法为每次肌肉注射1/3 LD梭曼（1 LD=10μg/kg）,每10 min追加1次。呼吸衰竭组以氧分压（PaO2）〈60 mmHg,二氧化碳分压（PaCO2）〉50mmHg、氧饱和度（SO2）〈90%为标准,在犬达呼吸衰竭标准后,立刻用宾赛克嗪0.1 mg/kg肌肉注射进行抢救。循环衰竭组以平均动脉血压降至45 mmHg为标准,在循环衰竭维持约6 h后使用宾赛克嗪0.1 mg/kg静脉注射进行抢救。检测两组梭曼染毒前、后及抢救后动脉血指标变化。以梭曼染毒前各指标为对照组,染毒后实验结果用SAS 6.12软件进行自身对照t检验分析。结果犬染毒1 h发生呼吸衰竭时,机体pH值由染毒前的7.290±0.040降低到7.150±0.050水平,PaCO2、PO2由染毒前的（42.6±3.6）和（92.0±6.4）mmHg改变为（56.1±6.5）和（38.4±9.3）mmHg,发生显著性差异（P〈0.01）,使用宾赛克嗪抢救6 h后,与呼吸衰竭酸中毒时相比pH值升高至7.290±0.110,恢复到染毒前水平,反映酸碱失衡的指标在2 h内均发生显著性改变（P〈0.05）。犬染毒2 h发生循环衰竭时,pH值由染毒前的7.345±0.064降低到6.956±0.022,且呈显著性下降（P〈0.01）,使用宾赛克嗪救治后,平均动脉血压、pH值分别升高到76 mmHg、7.185±0.029水平（P〈0.01,n=3～7）,反映酸碱失衡的指标部分有显著性差异。结论 ChEI梭曼中毒诱发犬发生呼吸与循环衰竭时产生酸中毒,使用宾赛克嗪药物抢救后,在酸中毒的早期可得到明显改善作用,后期则能够有效地控制恶化的程度。

Protection of benthiactzine on mixed type acidosis of concomitant respiratory failure and circulatory failure induced by intoxication of cholinesterase inhibitor

Objective To investigate the protection of new antidote benthiactzine on mixed type acidosis of concomitant respiratory failure and circulatory failure induced by intoxication of cholinesterase inhibitor（ChEI）.Methods Seven male dogs,weighing（12-15）kg,were injected intermuscularly 1/3 LD soman（1 LD=10 μg/kg）per ten minutes.The mean the pressure of carbondioxide decreased to 60 mmHg and the pressure of oxygen increased to 50 mmHg was defined as respiratory failure.The mean the blood pressure decreased to（40-45）mmHg was defined as circulatory failure.The changes of arterial blood were evaluated by an eight-channel direct-writing oscillograph,and were observed before and after soman injection.Statistical analysis of the data wag performed using the self control t test with the SAS 6.12 Software Program.Results The results indicated that PaCO2 and PO2 were（45.5±12.3） mmHg and（87.8±14.3） mmHg with significant difference（P〈0.01,n=7）;and BE,BB,SB and CH＋ were（-6.7±1.7） mmol/L,（41.1±1.8） mmol/L,（18.8±1.2） mmol/L,and（50.4±10.5） mmol/L,respectively.When it be continually treated above 6 h,the life feature be recovered in the acidosis dog.When the acidosis induced 2 h by the soman（4 LD） in dog,the blood pressure decreased,MAP was below 45 mmHg,and caused respiratory failure and circulatory failure.After treatment with benthiactzine 1 h,PaCO2,CH＋ and PO2 changed to（40.2±7.9） mmHg,（61.3±5.4） mmol/L,（114.5±27.1） mmHg,respectively,The other symptoms has not been continuously worsened,and acid poisoning was partially controlled.Conclusion Intoxiciation of cholinesterase inhibitors could lead to compensated primary acute respiratory acidosis complicating continuous metabolic acidosis.After treatment with benthiactzine,the symptoms of acidosis will be relieved,and broken away from the acidosis state.