国际麻醉学与复苏杂志   2019, Issue (4): 0-0
    
不同浓度布比卡因上胸段硬膜外阻滞对大鼠全脑缺血/再灌注损伤后的影响
石荷洁, 张中军, 霍星, 李玄1()
1.深圳市人民医院
Protective effects of high thoracic epidural anesthesia with different concentrations of bupivacaine on global cerebral ischemia/reperfusion injury in rats
 全文:
摘要:

目的 比较不同浓度布比卡因连续上胸段硬膜外阻滞(high thoracic epidural anesthesia, HTEA)对大鼠脑缺血/再灌注损伤(cerebral ischemia/reperfusion injury, CI/RI)后的影响,探讨其可能的作用机制,确定布比卡因HTEA的最佳浓度。 方法 将健康雄性Wistar大鼠(体重280~320 g)按照随机数字表法分为假手术组(SH组,6只)、CI/RI组(18只),再将CI/RI组按照随机数字表法分为对照组(C组)、HTEA1组、HTEA2组,每组6只。采用四动脉阻断法制作大鼠全脑缺血/再灌注模型,在此基础上进行HTEA,经T4-T5间隙硬膜外导管给药,HTEA1组给予0.250%布比卡因,HTEA2给予0.125%布比卡因,SH组及C组给予生理盐水,各组术前10 min开始20 μl/h连续泵入,直至取材。术中记录大鼠MAP、心率,术前及术后24 h对大鼠进行神经功能缺陷评分(Neurological Deficit Score, NDS),再灌注24 h后,处死大鼠取脑组织,对双侧海马进行H-E染色、尼氏染色、TUNEL染色,免疫组化检测趋化因子Fractalkine (FKN)的表达。 结果 与SH组比较,HTEA1组、HTEA2组及C组在缺血开始时MAP升高(P<0.05),再灌注时MAP降低(P<0.05),而3组间比较差异无统计学意义(P>0.05);各组间心率在各个时间点比较差异均无统计学意义(P>0.05);NDS评分减低,存活细胞数减少,凋亡细胞数增加,FKN表达增加(P<0.05)。与C组比较,HTEA1组与HTEA2组存活细胞数增加,凋亡细胞数以及FKN表达减少(P<0.05),MAP、心率和NDS评分差异无统计学意义(P>0.05)。HTEA1与HTEA2两组之间比较,各指标差异无统计学意义(P>0.05)。 结论 布比卡因HTEA可减轻大鼠CI/RI,两种浓度之间无差异。

关键词: 布比卡因; 麻醉,硬膜外; 脑; 再灌注损伤
Abstract:

Objective To compare the effects of high thoracic epidural anesthesia (HTEA) with different concentrations of bupivacaine on global cerebral ischemia/reperfusion injury (CI/RI) in rats. Methods Twenty-four male Wistar rats were randomly divided into four groups (n=6): a sham-operated group (SH group, 20 μl/h 0.9% saline), a control group (C group, 20 μl/h 0.9% saline), a high thoracic epidural anesthesia group 1 (HTEA1 group, 20 μl/h 0.250% bupivacaine), and a high thoracic epidural anesthesia group 2 (HTEA2 group, 20 μl/h 0.125% bupivacaine). Then, a global CI/RI model of rat was established by the four-artery occlusion method. During ischemia and reperfusion, the mean arterial blood pressure (MAP) and heart beat were recorded. The Neurological Deficit Score (NDS) was studied before ischemia and 24 h after CI/RI. The rats were sacrificed 24 h after reperfusion and the brains were collected for paraffin embedding. Hematoxylin-eosin (H-E) staining, Nissl-staining and TdT-mediated DUTP-biotin nick end labeling (TUNEL) staining were used to observe neurons in the hippocampus. The expression of fractalkine (FKN) proteins in the hippocampus were detected by immunohistochemical staining. Results Compared with the SH group, the HTEA1, HTEA2 and C groups showed remarkably increased MAP when ischemia began (P<0.05) and markedly decreased MAP during reperfusion (P<0.05), as well as remarkable increases in the number of apoptotic neurons and the expression of FKN and marked decreases in NDS and the number of survival neurons (P<0.05). Compared with the C group, the HTEA1 and HTEA2 groups presented an obviously increased number of survival neurons, and decreased number of apoptotic cells and FKN expression (P<0.05). There were no significant differences in MAP, HR and NDS among the C group and HTEA groups. Meanwhile, there were no significant differences in each indicator between the two groups. Conclusions HTEA with bupivacaine is beneficial to protect against ischemia/reperfusion injury in rats, without significant different effects between 0.125% and 0.250% bupivacaine.

Key words: Bupivacaine; Anesthesia, epidural; Brain; Reperfusion injury