2019 年第 1 期 第 14 卷

不同浓度罗哌卡因对家兔硬膜外麻醉中脊神经的毒性作用研究

Toxic effect of different concentrations of ropivacaine on spinal nerve in rabbits undergoing epidural anesthesia

作者：张琴韩志强段志强郑渤

英文作者：

单位：015000内蒙古自治区巴彦淖尔市医院麻醉科（张琴、段志强、郑渤）；010030呼和浩特，内蒙古医科大学附属医院麻醉科（韩志强）

英文单位：

关键词：硬膜外麻醉；罗哌卡因；局部麻醉药

英文关键词：

• 摘要：

• 【摘要】目的    探讨不同浓度罗哌卡因对家兔硬膜外麻醉中脊神经的毒性作用。方法    选择无特定病原体级健康成年家兔40只，雌雄不限，L6~L7间隙硬膜外麻醉置管成功后，采用随机数字表法分为4组，各10只，硬膜外导管分别注射0.2%、0.5%、1%罗哌卡因（0.2%罗哌卡因组、0.5%罗哌卡因组、1%罗哌卡因组）和0.9%氯化钠注射液（NS组）0.5 ml/kg,注药速度为0.05 ml/s。比较4组家兔给药前10 min，给药后10、30、60和90 min以及给药3 d后处死前的心率、收缩压、血氧饱和度以及后肢运动改良Tarlovs评分。给药3 d后对家兔进行心脏灌注处死,取脊神经制成苏木精-伊红染色冰冻切片及免疫组织化学石蜡切片，在显微镜下观察神经细胞Bcl-2的表达,通过Image-proplus计算神经细胞Bcl-2阳性细胞表达量。结果    0.5%罗哌卡因组和1%罗哌卡因组给药后30和60 min心率、收缩压、血氧饱和度均低于NS组，1%罗哌卡因组给药后30 min心率、收缩压和血氧饱和度均低于0.5%罗哌卡因组，差异均有统计学意义（均P<0.05）。给药后30和60 min，0.5%罗哌卡因组、1%罗哌卡因组Tarlovs评分均低于NS组（均P<0.05），0.2%罗哌卡因组与NS组比较差异均无统计学意义（均P>0.05）。1%罗哌卡因组、0.5%罗哌卡因组家兔脊神经Bcl-2阳性表达量高于NS组［（74.5±2.3）、（42.1±4.4）比（17.5±1.6）］，差异均有统计学意义（均P<0.01）,0.2%罗哌卡因组Bcl-2阳性表达量（20.6±1.8）与NS组比较差异无统计学意义（P>0.05）。结论    家兔硬膜外腔注射1%罗哌卡因后心率、血压、血氧饱和度均明显下降，后肢运动Tarlovs评分明显降低，Bcl-2表达量明显升高。

• 【Abstract】Objective    To analyze the toxicity of different concentrations of ropivacaine on spinal nerve in rabbits undergoing epidural anesthesia. Methods    Forty specific-pathogen-free healthy adult rabbits had epidural puncture at L6-L7 and they were randomly divided into 4 groups(n=10) which had epidural injection of 0.2% ropivacaine, 0.5% ropivacaine, 1% ropivacaine and 0.5 ml/kg 0.9% sodium chloride solution(NS group); the drug administration rate was 0.05 ml/s. Heart rate, systolic blood pressure, blood oxygen saturation and modified-Tarlovs score of hindlimb motor were recorded 10 min before and 10, 30, 60, 90 min, 3 d after drug administration. At 3 d after administration, the rabbits were sacrificed by heart perfusion and the spinal nerve was taken for hematoxylin-eosin frozen section and immunohistochemistry parafin section. Expression of Bcl-2 in nerve cells was observed under microscope and the Bcl-2 positive rate was calculated by Image-proplus. Results    Heart rate, systolic blood pressure and blood oxygen saturation 30, 60 min after administration in the 0.5% and 1% ropivacaine groups were significantly lower than those in the NS group; heart rate, systolic blood pressure and blood oxygen saturation 30 min after administration in the 1% ropivacaine group were significantly lower than those in the 0.5% ropivacaine group(all P<0.05). At 30 and 60 min after administration, Tarlovs score in the 0.5% and 1% ropivacaine groups were significantly lower than that in the NS group(all P<0.05). Bcl-2 positive expression quantity in spinal nerve in the 1% and 0.5% ropivacaine groups were significantly higher than that in the NS group［（74.5±2.3）,（42.1±4.4） vs （17.5±1.6）］（P<0.01）. Bcl-2 expression in the 0.2% ropivacaine group［（20.6±1.8）］ was similar to that in the NS group（P>0.05）. Conclusion    Epidural injection of 1% ropivacaine can significantly reduce heart rate, blood pressure, blood oxygen saturation, Tarlvos score and increase Bcl-2 expression in rabbits.