左旋布比卡因与布比卡因鞘内注射对犬脊髓及神经根超微结构的影响  

Effects of intrathecal anesthesia with levobupivacaine and bupivacaine on spinal cord and nerve roots in dogs

作　　者：吕娜[1,2] 郭建荣[2] 金孝岠[1] 苏永俊 刘洋[2] 

机构地区：[1]皖南医学院,安徽芜湖241000 [2]上海市浦东新区公利医院

出　　处：《山东医药》2014年第7期16-19,共4页Shandong Medical Journal

基　　金：上海市浦东新区卫生领先人才计划项目(PWR12013-03)

摘　　要：目的 观察常用浓度和剂量的左旋布比卡因与布比卡因鞘内注射对犬脊髓及脊神经根超微结构的影响.方法 健康杂种犬30只,随机分为5组.犬基础麻醉后行L3～L4脊椎间隙穿刺,有清亮通畅脑脊液（CSF）抽出后,于20 s内,C组注入生理盐水2 mL、L1组注入0.5％左旋布比卡因2 mL、L2组注入0.75％左旋布比卡因2mL、B1组注入0.5％布比卡因2 mL、B2组注入0.75％布比卡因2 mL.观察并记录各组注药前及注药后不同时间点血流动力学指标、动脉血气及CSF中氧分压（PO2）、乳酸值（Lac）的变化.注药后3h处死动物,取L1～L2段脊髓及脊神经根组织,测定脊髓组织中Ca2＋、MDA含量和SOD活力的变化,透射电镜观察脊髓及神经根组织超微结构的改变.结果 各组注药前、后各时点CSF的PO2及Lac值组间比较,P均＞0.05.注药3h后各组脊髓组织中Ca2＋、MDA含量及SOD活力变化组间比较,P均＞0.05.C组脊髓组织超微结构正常,内质网和线粒体结构完整清晰,神经髓鞘结构完整；B1、L1、L2组镜下结构相似,多数神经元结构基本正常,线粒体与内质网结构基本完整清晰,有髓神经纤维的板层结构基本正常；B2组神经元胞质接近正常,多数线粒体、内质网结构基本完整,少数线粒体结构肿胀明显,有髓神经纤维的板层结构基本完整,但部分出现局灶性水肿.结论 常用浓度的布比卡因、左旋布比卡因对脊髓及神经根组织未造成明显的缺血缺氧性损害,对脊髓组织损伤轻微,并未对脊髓组织造成直接的氧化损伤,对犬脊髓、神经根组织超微结构无显著影响,但随着局麻药浓度增加,其对脊髓神经系统的毒性作用有增强趋势.与布比卡因比较,相同浓度和剂量的左旋布比卡因对犬脊髓和神经根超微结构的影响更加轻微.Objective To investigate the effects of intrathecal anesthesia with different concentrations and doses of bupivacaine and levobupivacaine hydrochloride on spinal cord and nerve roots in dogs. Methods Thirty mongrel dogs were randomly divided into five groups. Lumbar puncture was made in the back at L3-L4 after base anesthesia, and when the ce- rebrospinal fluid flowed out, normal saline 2 mL, 0.5 % bupivacaine 2 mL, 0.75% bupivacaine 2 mL, 0. 5% levobnpiva- caine 2 mL and 0.75% levobupivacaine were intrathecally injected into group C, B1 , B2 , LI and L2 in 20 seconds. The hemodynamics, blood gas, PO2 and lactic acid （Lac） levels in CSF were measured before and at 1 h, 2 h and 3 h after in- trathecal administration. Three hours after intrathecal administration, the animals were sacrificed and L1 -L2 segments of spi- nal cord and nerve roots were immediately removed for Ca^2＋ , MDA contents and SOD activity determination and electron microscopic examination were conducted. Results The finding indicated that the levels of PO2 and Lac in CSF among five groups were not significant different （ all P 〉 0.05 ）. The contents of Ca^2 ＋ and MDA and activities of SOD were not signifi- cant different in all groups （ all P 〉 0.05 ）. Electron microscopic examination revealed that no obvious changes about neu- ron and nerve roots were observed in group C. While in the group B1 , L1 and L2 neurolemma of the nerve roots and the mi- tochondria and endoplasmic reticulum of the neurons in the spinal cord were basically intact, no significant difference of histological findings was observed in all groups. Electron microscopic examination also showed that the majority meta struc-ture of neuron intracytoplasm was distinct in group B2 and nerve root tissue had light focal dropsied, but myelin sheath and Schwann cell of nerve root were basically intact. Conclusions Intrathecal anesthesia with 0. 5% bupivacaine and levobupivacaine is safe and feasible and does not cause obvious ischemia anoxic damage on spinal cord and

关 键 词：左旋布比卡因 布比卡因 麻醉 脊髓 神经根 超微结构 钙离子 

分 类 号：R614.1[医药卫生—麻醉学]