国际麻醉学与复苏杂志   2018, Issue (11): 0-0
    
蛛网膜下腔-硬膜外联合麻醉后罗哌卡因硬膜外镇痛对家兔脊髓的影响
梁涛, 吴凡, 张少杰, 张曙光1()
1.内蒙古医科大学
Nerve injury caused by ropivacaine in analgesia pump in rabbit after combined spinal?蛳epidural anesthesia
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摘要:

目的 观察蛛网膜下腔-硬膜外联合麻醉(combined spinal - epidural anesthesia, CSEA)后家兔使用硬膜外泵注罗哌卡因镇痛对其脊髓的影响。 方法 家兔36只,采用随机数字表法分为3组(每组12只):A组为硬膜外麻醉(epidural anesthesia, EA)组、B组为CSEA组、C组为生理盐水组。麻醉前5 min,所有家兔均进行生命体征监测,选择L6-L7间隙行硬膜外腔置管,A组泵内配0.2%浓度的罗哌卡因20 ml;B组进行蛛网膜穿刺后,再进行硬膜外置管,也使用0.2%浓度的罗哌卡因20 ml;C组与B组操作相同,泵内注入生理盐水。各组实验动物分别于麻醉前5 min(T1)、麻醉后2 d(T2)和麻醉后7 d(T3)时记录生命体征,观察记录后肢活动度;各组分别于T2、T3时各处死6只动物,取脊髓标本检测Bcl?蛳2表达情况,检测细胞凋亡情况并计算细胞凋亡指数。 结果 各组动物生命体征数据差异无统计学意义(P>0.05);3组动物后肢活动度均无明显异常;脊髓结构基本正常;各组脊髓组织样本凋亡指数和Bcl?蛳2表达水平差异无统计学意义(P>0.05)。 结论 0.2%罗哌卡因用于硬膜外镇痛对家兔后肢活动度无显著影响,对家兔脊髓无损伤作用。

关键词: 罗哌卡因; 腰硬联合麻醉; 硬膜外阻滞; 镇痛; 脊髓
Abstract:

Objective Using analgesia pump to rabbit after combined spinal- epidural anethesia(CSEA), then observing injury to spinal cord which is induced by ropivacaine. Methods Thirty six white rabbits of either sex weighing 2.0-2.5 kg were randomly divided into three groups (n=12): group A, EA (epidural anesthesia); group B, CSEA; group C, CSEA (NS). Each group is killed at 2 d and 7 d. All rabbits are monitored hemodynamic parameters by monitor and cathetered in L6-L7. Group A connect analgesia pump (0.2% ropivacaine 20 ml), group B puncturing subarachnoid, then connect analgesia pump (0.2% ropivacaine 20 ml) too, group C puncturing subarachnoid, then connect analgesia pump (NS 100 ml). Assessing and recording the degree of motor block at 2 d and 7 d. Resectting the lumbar segments of spinal cord for histologic examination, observation of apoptosis and expression of Bcl-2. Results Compared with anatomical control, structure of the spinal cords are normal. Injury caused by oppression and penetration can not be observed in group C. Compared with positive control.no significant differences in the activity of hind legs in group A, group B and group C. Apoptotic index and Bcl-2 expression levels in each groups had no significant differences too (P>0.05). Conclusions Point two percent ropivacaine in analgesia pump would not cause injury on spinal cord and affect the activity of the hind limbs. NS in analgesia pump would not cause injury through oppression and penetration. 0.2% ropivacaine in analgesia pump can not affect hemodynamic parameters of rabbit.

Key words: Ropivacaine; Combined spinal- epidural anesthesia; Epidural block; Analgesia rabbit; Spinal cord