蛛网膜下隙应用罗比卡因对家兔脊髓和脊神经根的毒性作用  

The toxic effect of intrathecal ropivacaine on spinal cord and spinal nerve roots in rabbit

作　　者：续飞[1] 修培宏[1] 高尔[2] 邵维忠[3] 曹焕军[2] 李玉红[1] 

机构地区：[1]山东省聊城市人民医院麻醉科,252000 [2]潍坊医学院麻醉学研究室 [3]潍坊市人民医院麻醉科

出　　处：《临床麻醉学杂志》2005年第11期776-778,共3页Journal of Clinical Anesthesiology

摘　　要：目的家兔蛛网膜下隙注入不同剂量的0.75%罗比卡因后,观察脊髓和脊神经根在光镜和电镜下的改变,以及脊神经纤维的髓鞘面积、轴突面积及其面积比的改变,评价罗比卡因蛛网膜下隙用药的安全性。方法健康家兔24只,雌雄不拘,体重(2.0±0.2)kg。随机分为四组:Ⅰ组6只,0.75%罗比卡因2 mg;Ⅱ组6只,0.75%罗比卡因3 mg;Ⅲ组6只,0.75%罗比卡因4 mg;Ⅳ组(对照组)6只,生理盐水0.2 ml。在蛛网膜下隙穿刺注入生理盐水和罗比卡因后6 h灌注固定,分别从L1及L5脊髓和脊神经根处各取一份标本,染色后作光镜观察及测量,取L1脊髓后角组织和脊神经根作电镜观察。结果光镜下Ⅳ组无明显改变,Ⅰ组和Ⅱ组同Ⅳ组,Ⅲ组中有部分家兔脊髓神经细胞出现水肿,浆内尼氏小体欠清,个别神经节细胞水肿。各组神经根无明显改变,神经纤维的髓鞘面积、轴突面积及其面积比均无显著改变。电镜下Ⅳ组结构基本正常,Ⅰ组和Ⅱ组部分髓鞘出现分离及排列紊乱,Ⅲ组部分髓鞘出现分离及排列紊乱,有的出现断裂,部分线粒体出现空泡变性,少数粗面内质网脱颗粒。结论家兔蛛网膜下隙应用0.75%罗比卡因2 mg可引起髓鞘分离及排列紊乱。Objective To observe the changes of spinal cord and spinal nerve under light microscop and elytrorrhaphy after intrathecal（IT） administration of different dose of 0.75% ropivacaine in rabbits. Methods Twenty-four mongrel rabbits weighing were randomly assigned to four groups with 6 rabbits each. Group Ⅰ received normal saline 0.2 ml IT and served as control, group Ⅱ 0.75% ropivacaine 2 mg IT,group Ⅲ 0.75% ropivacaine 3 mg IT,and group Ⅳ 0.75% ropivacaine 4 mg IT. Normal saline or vations doses of ropivacaine was injected into the subarachnoid space, 6 h after IT administration,the animal was fixed by a fixative solution, L1 and L5 segment of spinal cord and nerve roots were removed and stained for light microscope examination and measurement, Spinal cord posterior horn and nerve roots of L1 were choosen for electron microscopic examination. Results Light microscope revealed that in control group Ⅰ there were no obvious changes, The results of group Ⅱ and Ⅲ were the same as the control. In group Ⅳ some nerve cells in the spinal cord appeared edema,nissl body was not clear, some nerve cells in ganglion appeared edema, nerve roots were no obvious change in all groups. The myelin area, axis-cylinder area and the ratio between them were not significantly changed （P〉0.05）. Electron microscope revealed that in group Ⅰ the ultrastructure were not obviously changed, In group Ⅱ and Ⅲ, some myelin appeared isolation and disorder. In group Ⅳ some myelin appeared isolation and disorder, some appeared disruption. Some mitochondria appeared vacuolation,and minority endoplasmic reticulum＇s ribosome was lost. Conclusion Intrathecal administration of 0.75 % ropivacaine 2 mg in rabbits can cause myelin isolation and disorder.

关 键 词：罗比卡因 脊椎麻醉 脊神经根 神经毒性 

分 类 号：R614[医药卫生—麻醉学] R714.3[医药卫生—外科学]