超声介导微泡破裂增强利多卡因神经阻滞效果的实验研究

曾令清; 鲍红光; 斯妍娜; 景灵; 耿圆; 孙蓓; 蒋卫清

超声介导微泡破裂增强利多卡因神经阻滞效果的实验研究

Ultrasound targeted microbubble destruction enhances the effects of lidocaine on sciatic nerve blockade in rats

摘要

摘要: 目的评价超声介导微泡破裂对利多卡因神经阻滞效果的影响。方法清洁级雄性SD大鼠72只，体质量200~300 g。随机分为6组(n=12)：空白对照组(C组)、1％利多卡因水溶液组(L1组)、1％利多卡因+微泡组(LM1组)、2％利多卡因水溶液组(L2组)、2％利多卡因+微泡组(LM2组)和空白微泡组(M组)。于大鼠坐骨神经阻滞前，阻滞后10、20、30、45 min,1、2、4、6、8、10和12 h进行感觉和运动评定。分别以感觉阻滞的最大可能效应（MPE）和大鼠后肢蹬力（EPT）评估感觉和运动阻滞程度。于大鼠坐骨神经阻滞前、阻滞后2天和1周时行改良Tarlov评分；于坐骨神经阻滞后1 周行病理学观察，Western blot法测定坐骨神经S100表达水平。结果与阻滞前相比，L1组在阻滞后10 min~1 h、LM1组和L2组在阻滞后10 min~2 h、LM2组在阻滞后10 min~6 h各时间点MPE升高（P<0.05）；与L1组相比，LM1组MPE在阻滞后30 min~2 h升高（P<0.05）；与L2组相比，LM2组MPE在阻滞后30 min~6 h升高（P<0.05）。与阻滞前相比，L1组在阻滞后10 min~45 min、LM1组和L2组在阻滞后10 min~1 h、LM2组在阻滞后10 min~2 h各时间点EPT降低（P<0.05）；与L1组相比，LM1组EPT在阻滞后30 min~1 h降低（P<0.05）；与L2组相比，LM2组EPT在阻滞后45 min~2 h降低（P<0.05）。与C组相比,L2和LM2组在阻滞后2天改良Tarlov评分较阻滞前降低(P<0.05)。阻滞后1周时，L2组和LM2组可见轻度坐骨神经损伤，坐骨神经S100表达增加。结论超声介导微泡破裂可以显著增强利多卡因神经阻滞强度，延长阻滞时间，且生物相容性良好。超声介导微泡破裂下2%利多卡因的坐骨神经阻滞效果优于1%利多卡因，但存在神经损伤的可能性。

Abstract: ObjectiveTo investigate the influence of ultrasound targeted microbubble destruction (UTMD) on the effects of lidocaine on sciatic nerve blockade (SNB) in rats. MethodsA total of 72 male SD rats weighing 200-300 g were randomly divided into six groups (n=8): a blank control group (Group C), a 1% lidocaine group (Group Ll), a l% lidocaine+microbubble group (Group LM1), a 2% lidocaine group (Group L2), a 2% lidocaine+microbubble group (Group LM2), and a microbubble group (Group M). Then, the maximum possible effect (MPE) and extensor postural thrust (EPT) were measured to evaluate the sensory and motor function of the hind limbs before SNB and 10, 20, 30, 45 min, 1, 2, 4, 6, 8, 10 and 12 h after SNB. The modified Tarlov scores were measured before SNB, and 2 days and 1 week after SNB. The right sciatic nerves were removed for morphology observation 1 week after SNB. The levels of S100 in sciatic nerves were determined by Western blotting. ResultsCompared with the value before SNB, the MPE was significantly increased 10 min-1 h after SNB for Group L1, 10 min-2 h after SNB for Groups LM1 and L2, and 10 min-6 h for Group LM2 (P<0.05). Compared with Group L1, the MPE was significantly increased 30 min-2 h after SNB for Group LM1 (P<0.05). Compared with Group L2, the MPE was significantly increased 30 min-6 h after SNB for Group LM2 (P<0.05). Compared with the value before SNB, the EPT was significantly decreased 10-45 min after SNB for Group L1, 10 min-1 h after SNB for Groups LM1 and L2 and 10 min-2 h after SNB for Group LM2 (P<0.05). Compared with Group L1, the EPT was significantly decreased 30 min-1 h after SNB for Group LM1 (P<0.05). Compared with Group L2, the EPT was significantly decreased 45 min-2 h after SNB for Group LM2 (P<0.05). Compared with the value before SNB, the modified Tarlov scores were significantly decreased 2 days after SNB for Groups L2 and LM2 (P<0.05). Modest nerve injury and increased S100 expression were observed in Groups L2 and LM2 one week after SNB. ConclusionsUTMD can enhance the effects of lidocaine on sciatic nerve blockade in rats, with good biocompatibility. The efficacy of 2% lidocaine under UTMD is superior to that of 1% lidocaine, but may possibly induce nerve injury.

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