麻醉药膏“PROAEGIS”涂抹致死案例并文献复习  

A case of death caused by the anesthetic ointment"PROAEGIS"and related literature review

作　　者：常靖 魏春明 任昕昕 张云峰 宋歌 王瑞花 李佳宜 Chang Jing;Wei Chunming;Ren Xinxin;Zhang Yunfeng;Song Ge;Wang Ruihua;Li Jiayi(Institute of forensic science,MPS,Beijing,100038 China)

机构地区：[1]公安部鉴定中心,北京100038

出　　处：《中国法医学杂志》2023年第5期583-586,589,共5页Chinese Journal of Forensic Medicine

基　　金：公安部鉴定中心基本科研业务项目(2021JB003)。

摘　　要：目的 近年来,非正规医美机构使用“PROAEGIS”“TKTX”“超强眼部舒缓乳”等假劣麻醉药膏用于文眉、文身,其中利多卡因、丁卡因或其他局麻药单一或混合为主要成分,本文总结了此类假劣麻醉药膏特征和利多卡因、丁卡因的中毒及死后毒物学特点,为法医毒物分析工作者提供借鉴。方法 介绍本实验室一例涂抹“PROAEGIS”假劣麻醉药膏致死案例,同时检索了已报道利多卡因、丁卡因相关死亡案例、中毒研究文献24篇,回顾性分析了利多卡因、丁卡因的中毒特征、体内代谢、分布、死后毒物学数据等。结果 利多卡因起效快、持续作用时间短,丁卡因起效慢、持续作用时间长,血药峰值浓度分别在5μg/mL、2μg/mL以下安全,但丁卡因安全范围窄,剂量和配比使用不当易发生中毒或过敏性猝死,喉头水肿是其典型特征;利多卡因、丁卡因在体内均易代谢,利多卡因主要代谢物为单乙基甘氨酸二甲苯胺(MEGX),丁卡因主要代谢物为对丁氨基苯甲酸(BABA);本案死者心血中检出利多卡因、对丁氨基苯甲酸,含量分别为1.8μg/mL、 9.32μg/mL,未检出丁卡因,单乙基甘氨酸二甲苯胺未检验。结论 利多卡因常与丁卡因或其他局麻药物联合使用,且利多卡因和丁卡因在体内均易代谢,尤其是丁卡因代谢快、原体含量低,代谢物的检测在中毒死因判定中起着关键作用。因此,对于利多卡因与丁卡因中毒案件,法医毒物检验应对原体和代谢物均进行检测。Objective In recent years,Fake and inferior anesthetic cream,such as PROAEGIS,TKTX,Super soothing eye lotion and so on,have been used by illegal clinic and beauty parlor for eyebrow tattooing and body tattooing,in which lidocaine,tetracaine or other local anesthetics are main ingredients with single compound or multiple compounds.In this paper,fake creams were summarized for its characteristics,the poisoning and postmortem toxicology characteristics of lidocaine and tetracaine were reviewed,so as to provide reference for forensic toxicologist.Methods A case of death caused by the application of anesthetic cream named PROAEGIS in our laboratory was reported,and 24 papers about lidocaine and tetracain-related deaths and poisoning studies published were retrieved,and the poisoning characteristics,metabolism,distribution and postmortem toxicological data of lidocaine and tetracaine were retrospectively analyzed.Results Anesthetic effect of lidocaine works quickly and lasts for a short time,while tetracaine works slowly and lasts for a long time.The peak blood concentration of lidocaine and tetracaine is safe below 5μg/mL and 2μg/mL,respectively.The safe dose range of tetracaine is very narrow,and overdose can lead to poisoning or sudden allergic death,laryngeal edema is typical symptom.Both lidocaine and tetracaine are metabolized in vivo,monoethyl glycine dimethylaniline(MEGX)is the main metabolite of lidocaine,and p-butylaminobenzoic acid(BABA)is the main metabolite of tetracaine.In this case,lidocaine and p-butylaminobenzoic acid were detected in the deceased's heart blood,the contents of which were 1.8μg/mL and 9.32μg/mL respectively,while tetracaine was lower LOD which is ng/mL by LC-MS/MS,and monoethyl glycine dimethylaniline was not tested.Conclusion Lidocaine is often used in combination with tetracaine or other local anesthetics,and both lidocaine and tetracaine are easily metabolized in the body,especially tetracaine can be quickly metabolized and is low concentration in biology samples,so the detection

关 键 词：麻醉药膏 利多卡因 丁卡因 中毒 毒物检验 

分 类 号：D918.93[政治法律—法学]